Effectiveness of combination antiretroviral therapy on survival and opportunistic infections in a developing world setting - An observational cohort study

Background: The prolonged effectiveness of antiretroviral therapy (ART) in a developing country is not well established. Methods: An observational database was established at the HIV clinic of the Almenara Hospital in Lima, Peru in 1996. All 564 initially arifiretroviral-naive HIV-infected persons (mean CD4 count of 91 cells/mm(3)) who received combination ART were followed overtime. Results: The overall survival rate was 96% at year 2, 94% at year 4, and 91% at year 5. Among persons who initiated therapy with CD4 counts < 100 cells/mm(3), the overall survival rate at 3 years was 95%. Opportunistic infections while on ART occurred in 20% of persons. Patients who received 2 reverse transcriptase (RT) inhibitors plus a protease inhibitor had slightly better survival rates and less opportunistic disease in the first year of therapy as compared with those receiving 2 RT inhibitors and a nonnulcleoside reverse transcriptase inhibitor or 3 RT inhibitors. Conclusions: This study demonstrates the long-term effectiveness of ART in a developing country urban setting. It provides evidence of the importance of continuing global financing initiatives to provide widespread HIV therapy for countries in the developing world.