Page 238 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Virologic and immunologic responses of patients on

highly active antiretroviral therapy in a rural

community health centre in Limpopo,

South Africa: A retrospective study

Authors: Background: South Africa has a high HIV burden. Despite increased uptake of persons living
Aniekan Edet with HIV into the South African national antiretroviral therapy programme, the incidence of
1,2
Henry Akinsola 1
Pascal O. Bessong 3 HIV increased between 2013 and 2016. Studies suggest that increased community viral
suppression results in reduced HIV incidence in that community ‘independent of unsafe
Affiliations: sexual behaviours and sharing used syringes’.
1 Department of Public
Health, University of Venda, Objective: The aim of this study was to investigate the viral and immunologic responses of
Thohoyandou, South Africa patients, in a rural community health centre in South Africa, to combination antiretroviral
therapy (cART) between January 2004 and July 2016.
2 Department of Family
Medicine, Tshilidzini Methods: This was a retrospective medical record review conducted in Thohoyandou
Hospital, Thohoyandou,
South Africa Community Health Centre. Data analysis was done using SPSS 24.0 and Microsoft Excel. The
estimates used were 95% confidence intervals, and a p-value < 0.05 was considered to be
3 HIV/AIDS and Global Health statistically significant.
Research Programnme,
Department of Microbiology, Results: Analysis was done using 1247 individuals, with 76% of the cohort being female and
School of Mathematical and 98% first-line cART. The proportion of patients with a suppressed viral load (VL) at 6 months
Natural Sciences, University post-treatment was 64%, and 72% at 60 months. Fifty-nine per cent had consistent viral
of Venda, Thohoyandou,
South Africa suppression over a 6-month period and 14% over at least 54 months. The mean CD4+ cell
count at baseline was 227 cells/µL, and 538 cells/µL at 60 months. Multivariate regression
Corresponding author: analysis revealed that males had poorer immunologic and virologic responses.
Aniekan Edet,
[email protected] Conclusions: Viral suppression in the study population was inferior to the UNAIDS target of
90%. The sustainability of viral suppression, once attained, was also low. These may have a
Dates:
Received: 09 Nov. 2017 negative impact on HIV transmission.
Accepted: 27 Feb. 2019 Keywords: HIV; Viral suppression; CD4+ Cell count; Limpopo; South Africa.
Published: 22 May 2019

How to cite this article:
Edet A, Akinsola H, Introduction
Bessong PO. Virologic and
immunologic responses The prevalence of HIV in South Africa increased from 6.19 to 7.03 million between 2013 and the
of patients on highly active end of 2015. Despite an increased uptake of persons living with HIV into the national antiretroviral
antiretroviral therapy in a
rural community health centre therapy programme over the years, the incidence rate also increased from 340 000 new cases per
in Limpopo, South Africa: annum to 380 000 cases per annum during the same period. 1,2,3 With the scale-up of the antiretroviral
A retrospective study. S Afr therapy programme, the prevalence of viral suppression is expected to increase, with associated
J HIV Med. 2019;20(1), a818. reduction in HIV incidence. Studies have suggested that increased community viral suppression
https://doi.org/ 10.4102/
sajhivmed.v20i1.818 results in reduced HIV incidence in that community ‘independent of unsafe sexual behaviours
and sharing used syringes’. The Partner study found ‘zero transmission’ when the viral load
4,5
Copyright: (VL) at most 1 year before was less than 200 copies/mL. To curb its high HIV burden, South Africa
6
© 2019. The Authors. adopted the UNAIDS ‘90-90-90 targets’. This target aims to attain sustained viral suppression in
Licensee: AOSIS. This work
is licensed under the 90% of all persons receiving antiretroviral therapy by the year 2020.
Creative Commons
Attribution License. Over the years, several definitions have been used to define viral suppression and virologic
failure, with different definitions recommended for low- to medium-income countries, compared
7
Read online: to high-income countries. The South African National Department of Health (NDoH), however,
Read online:
Scan this QR
Scan this QR recommends the use of VL ≤ 50 copies/mL as definition for viral suppression and two
code with your 8
code with your
smart phone or VL results > 1000 copies/mL to define viral failure. Bartlett et al. state that maintaining the VL at
smart phone or
mobile device
mobile device ≤ 50 copies/mL is associated with the most durable clinical benefits. The CD4+ cell response to
9
to read online.
to read online.
combination antiretroviral therapy (cART) is, however, more variable. It increases rapidly in the
http://www.sajhivmed.org.za 231 Open Access