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Abstract
High frequency of clinical progression and virological failure among patients on antiretroviral treatment admitted to an ambulatory HIV clinic in Puerto Vallarta, Mexico
Vargas-Infante Y.A.1, Martínez-Mendizabal A.1, Pérez-Flores M.2, Ruíz-Orozco M.3, Campos-López P.4, Saavedra J.5, Chang H.6
Objectives: To describe the frequency and causes of clinical progression and antiretroviral failure(VF) in patients admitted to a specialized HIV Clinic in the province of Mexico.
Methods: Cross-sectional study of all patients admitted from November 2006 to February 2007. Demographic, clinical and laboratory data were evaluated by individual interviews and chart review. VF was defined as failure to suppress HIV-1 RNA by 1 log 10 copies/mL or rebound by Week 32 [early] and failure to suppress HIV-1 RNA to < 200 copies/mL or rebound after Week 32 [late].
Results: 108 HIV patients were admitted during the study period, 67(62%) from the local free-access program, 25(23%) referred from specialized clinics and 16(15%) newly diagnosed. Median age was 35 yr-old (19-70). 85(79%)men, 58(54%) single, 59(55%) heterosexual, 53(49%) illicit-drug abusers and 16(15%) IDU´s. At diagnosis, 27(25%) patients were asymptomatic and 65(60%) had AIDS; tuberculosis (13%) was the main opportunistic disease. 76(70%) patients had been evaluated with CD4+ count and 53(49%) with HIV-RNA viral load as initial approach. Sixty-one of 83(73%) patients on antiretroviral treatment(ART) had 60 days or more on a continuous regimen. We confirmed virological failure(VF) in 19/61(31%)cases. The median exposure to ARV was 90 and 64 weeks, in the patients with and without VF, P=0.13. Eight(50%)patients with VF had developed opportunistic diseases after 9(2-21) months despite ART. Self-reported adherence to ART among patients with VF was >95% in 7(37%) cases and <80% in 11(58%).
In the univariate analysis, the inadequate prescription of ART [OR 4.8(95%IC 0.1-0.4), P<0.003] and depression [OR 3.1(95%IC 1.0-9.7), P=0.04] were main risk factors for VF. The inadequate prescription remained as significant risk factor in the multivariate analysis.
Conclusions: Clinical progression and VF among HIV-patients on ART were highly frequent in this study. Increasing access to ART should include more resources for continuous medical education and paraclinic assessment in poor resources.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
CDB301
Suggested Citation
"Vargas-InfanteY.A., et al.
High frequency of clinical progression and virological failure among patients on antiretroviral treatment admitted to an ambulatory HIV clinic in Puerto Vallarta, Mexico.
:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
CDB301"
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