Programme Supplement [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Late Breaker Abstracts

Methods: From 1995, the Entebbe cohort (EC) has enrolled and
followed HIV-infected adults. Since 2003, ART has been available
through the DART (Development of ART in Africa) trial. ART impact
was assessed by comparing mortality and causes of death, before
2000, in EC participants fulfilling DART entry criteria with that
observed in 2 years of DART.
Results:

rate = 0.007 deaths/patient-month]. The risk of AIDS death was
significantly increased with lower baseline CD4 counts.
CD4 count (cells/ Adjust.d hazard r ti

mm3)
< 50
50 - 99
100 - 199
> 200

( cIza) ra
(95% Cr)

P-value

6.1 (4.5-8.4)
3.1 (2.2-4.3)
1.8 (1.3-2.5)
1.0 (reference)

< 0.001
< 0.001
< 0.001

Period of observation

Entebbe Cohort 1995
- 2000

DART Trial 2003
- 2006

Person years of follow-up 658
Median CD4 cells/mm3 at 75 (23 - 130)
enrolment (IQR) 75 (23- 130)
Number of Deaths / Total 380 / 516
enrolled380 / 516
enrolled
Overall mortality rate per 1000 577.2
person-years
Survivalrprobability 1 year after 0.547 (0.501-0.591)
enrolment (95%CI) 0.5 (0. -0.1)
Survival probability 2 years 0.275 (0.233-0.318)
after enrolment (95%CI) 0 (0.233-0.31)

1819
93 (31 - 145)
62 / 1015
34.1
0.950 (0.934-0.961)
0.938 (0.921-0.952)

Overall mortality Rate Ratio 16.9 (12.9 0 221.1) p<0.001.
Mortality was highest in patients with CD4<50 cells/mm3 at
enrolment though survival was still significantly higher (rates
953 versus 60.4 per 1000 person-years; RR 15.8). The leading
specific cause of death in EC was Cryptococcus (64 deaths; 16.8%)
followed by Cryptosporidium(18 deaths; 4.7%) and tuberculosis
(16 deaths; 4.2%). HIV wasting was the predominant syndrome
(111 deaths; 29.2%). The leading specific cause of death in DART
was tuberculosis (10 deaths; 16.1%), followed by malignancy (6
deaths; 9.7%) and bacteraemia (5 deaths; 8.1%). Acute fever
was the leading syndrome (12 deaths; 19.3%) and HIV wasting
virtually disappeared as a cause of death (an estimated 234-fold
reduction).
Conclusions: First-line ART guided by clinical and immunological:
monitoring is highly effective: two year survival is 94% with
overall mortality reduced 17-fold compared to a matched preART cohort. Significant benefit accrues even in adults with very
advanced disease.
THLB0209
Rapid expansion of the national antiretroviral treatment
program in Thailand: program outcomes and patient
survival, 2000-2005
Ningsanond P.1, Lertpiriyasuwat C.1, McConnell M.2, Chasombat
S.1, Siangphoe U.2, Mock P.2, Fox K.2, Thanprasertsuk S.'. 'Bureau
of AIDS, TB, and STIs, Department of Disease Control, MOPH,
Thailand, Nonthaburi, Thailand, 2Global AIDS Program, Thailand
MOPH-US CDC Collaboration, Thailand, Nonthaburi, Thailand
Background: Antiretroviral treatment (ART) is increasingly
available for HIV-infected persons in resource-limited settings.
In Thailand, the Ministry of Public Health initiated a national ART
program in 2000 and rapidly expanded access across the country.
Thai guidelines recommend initiating antiretrovirals at CD4 count
<200 cells/mm3 or symptomatic HIV with CD4 count <250 cells/
mm3. The first-line ART regimen includes stavudine, lamivudine,
nevirapine.
Methods: Demographic and clinical data were reported by 746
(98%) of 756 participating hospitals. To allow for reporting delays,
data analysis included patient visits through March 2005. Lost
to follow-up was defined as >9 months without a visit. Survival
probability was estimated with Kaplan-Meier and Cox regression
analyses.
Results: Data were available from 42,139 patients enrolled
January 2000-March 2005; 82.8% enrolled in 2003-2004. Of
enrollees, 52.2% were male, and median age was 34.1 years. At
baseline, 49.3% had clinical AIDS; the median CD4 count was 46
cells/mm3 (inter-quartile range=14-131). Initial treatment included
nevirapine- (90.2%) and efavirenz- (8.1%) based regimens.
At follow-up, 85.1% of patients remained on treatment, 2.6%
stopped antiretrovirals, 5.4% were lost to follow-up, 6.2% died
due to AIDS, and 0.7% died not due to AIDS [crude AIDS death

Among 13,192 patients with 12 months of follow-up, 89.9%
remained on the baseline regimen.
Conclusions: In Thailand, there has been rapid scale-up of
national ART. Early ART initiation was associated with reduced
mortality; program efforts should promote early identification of
HIV infection and early access to treatment.
THLB0210
High prevalence and mortality from extensively-drug
resistant (XDR) TB in TB/HIV coinfected patients in rural
South Africa
N.R. Gandhi', A. Moll2, R. Pawinski3, A.W. Sturm4, U. Lalloo3, K.
Zellers, J. Andrews', G. Friedland6. 'Emory University School of
Medicine, Division of Infectious Diseases, Atlanta, United States,
2Church of Scotland Hospital and Philanjalo, Tugela Ferry, KwaZulu
Natal, South Africa, 3Nelson R. Mandela School of Medicine,
Enhancing Care Initiative, Durban, South Africa, 4Nelson R.
Mandela School of Medicine, Department of Medical Microbiology,
Durban, South Africa, 5Brown Medical School, Department of
Family Medicine, Providence, United States, 6Yale University School
of Medicine, Yale AIDS Program, New Haven, United States
Background: In a rural district in KwaZulu Natal, South
Africa, where the TB/HIV coinfection rate is greater than 80%,
antiretroviral therapy (ARV) has significantly reduced mortality.
Of the remaining deaths, 67% have been documented to be due to
multi-drug resistant (MDR) TB. We sought to determine the extent
and consequences of MDR TB among patients in this district.
Methods: Surveillance with sputum culture and drug susceptibility
testing was performed for patients with known or suspected TB in
a rural district hospital. Spoligotyping was performed on isolates
resistant to all tested TB drugs (isoniazid, rifampin, ethambutol,
streptomycin, ciprofloxacin, kanamycin).
Results: Between January 2005 and March 2006, sputum collected
from 1540 patients revealed that 536 (35%) patients were culture
positive for M.tb. Of these, 221 (41%) had MDR TB, and 53 (24%
of MDR isolates, 10% of all positive cultures) had resistance to all
first and second line drugs tested (XDR TB). Spoligotyping revealed
90% of XDR TB patients were infected with a genetically similar
strain. 52 of 53 (98%) XDR TB patients have died; the median
survival after sputum collection was 25 days (range: 11-136). All
47 XDR TB patients with known HIV status, were HIV positive.
Only 34% of patients were previously treated for TB and 56% had
been previously hospitalized.
Conclusions: Increased surveillance in rural South Africa revealed
a markedly greater MDR TB prevalence than previously recognized,
with evidence of recent nosocomial and community transmission of
XDR TB in HIV coinfected patients. The convergence of the TB/HIV
epidemic with MDR and XDR TB in resource poor settings is a deadly
threat to gains in survival achieved by TB DOTS and ARV therapy.
THLBO211
Efavirenz (EFV)-based regimens are potent in treatmentnaive subjects across a wide range of pre-treatment HIV-1
RNA (VL) and CD4 cell counts: 3-year results from ACTG
5095 (A5095)
Ribaudo H.', Kuritzkes D.2, Lalama C.1, Schouten j.3, Schackman
B.4, Gulick R.5, AIDS Clinical Trials Group. 'Harvard School of
Public Health, Biostatistics, Boston, United States, 'Harvard
Medical School, Section of Retroviral Therapeutics, Boston, United
States, 'University of Washington, Seattle, United States, 4Weill

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XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * PROGRAMME SUPPLEMENT