About 60% Of HIV-Positive People Who Begin Antiretroviral Treatment Still Taking Drugs After Two Years

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About 60% of HIV-positive people in sub-Saharan Africa who begintreatment with antiretroviral drugs still are taking the drugs aftertwo years, according to a study published Monday in PLoS Medicine, the AP/Los Angeles Times reports.

For the study -- led by Sydney Rosen, an assistant professor at Boston University's School of Public Health-- researchers examined 32 publications that reported on 74,192 peopleliving with HIV/AIDS in 13 countries in sub-Saharan Africa between 2000and 2007. The study found that 40% of the people who stopped treatmenthad died. The rest of the patients who stopped treatment missedscheduled medical appointments, failed to pick up medication ortransferred to other clinics. In addition, a small percentage of peoplestopped treatment with antiretrovirals but continued to receive medicalcare at the same clinic where they began treatment (Cheng, AP/Los Angeles Times, 10/15).

Accordingto the researchers, there are several possible reasons for the study'sfindings. Many patients' HIV was so far advanced when they begantreatment that they died within a few months, the researchers found.Some people stopped treatment because they were unable to findtransportation to clinics or were unable to afford antiretrovirals,according to the study. The study also found that success rates variedby program and country. One program in South Africa retained about 85%of people after two years, compared with a retention rate of 46% at aclinic in Uganda (BBC News, 10/16). The World Health Organization estimates that antiretroviral treatment programs in Western countries retain about 80% of people after two years.



Although a 60% adherence rate is not "fabulous," the study could beconsidered a "success story" in terms of "deaths avoided and orphansavoided," Rosen said. Charlie Gilks, director of treatment at WHO's HIV/AIDS Departmentwho was not involved with the study, said, "We clearly should be doinga lot better than 60%, but that is much more difficult than justidentifying patients and getting the first pills into their mouths."Gilks said the data examined in the study are several years old, addingthat he thinks an increased number of people now are adhering to theirtreatment regimens, although there is not evidence to confirm it.

According to the AP/Times,establishing smaller clinics outside urban areas might help increasetreatment retention. "Once you get more than 1,000 to 1,500 patients,the services get congested and patient adherence rates go down," Gillesvan Cutsem -- AIDS project coordinator for Medecins Sans Frontieresin Khayelitsha, South Africa, who was not involved with the study --said. He added, "If we only treat patients in big clinics, then we aresacrificing the ones who are very sick who cannot walk very far."

Someexperts also emphasized the importance of educating people on thesignificance of treatment and preventing the spread of HIV. AlisonGrant, an HIV/AIDS epidemiologist at the London School of Hygiene and Tropical Medicine,said, "We need to help patients have a clear understanding of why theyshould take their antiretrovirals and what will happen to them if theydon't." Daniel Halperin of the Harvard School of Public Healthsaid that the "best treatment is prevention." He added, "If we canprevent this epidemic, then that will solve a lot of the treatmentissues eventually. ... Otherwise, we may not be able to keep up with somany patients" (AP/Los Angeles Times, 10/15).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . TheKaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service ofThe Henry J. Kaiser Family Foundation.