Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Suely Hiromi Tuboi, Antonio Guilherme Pacheco, Lee H. Harrison, Roslyn A. Stone, Margaret May, Martin W.G. Brinkhof, François Dabis, Matthias Egger, Denis Nash, David Bangsberg, Paula Braitstein, Constantin T. Yiannoutsos, Robin Wood, Eduardo Sprinz, Mauro Schechter

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


OBJECTIVES: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. METHODS: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. RESULTS: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. CONCLUSIONS: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Antiretroviral therapy
  • CD4 lymphocyte count
  • Cohort
  • Highly active
  • Low-income population
  • Mortality
  • Treatment outcome
  • Viral load

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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