The Efficacy of Combination Antiretroviral Therapy in HIV Type 1-Infected Patients Treated in Curaçao Compared with Antillean, Surinam, and Dutch HIV Type 1–Infected Patients Treated in The Netherlands

Abstract

We compared the efficacy of combination antiretroviral therapy (cART) of Antillean HIV-1-infected patients treated on the Caribbean island of Curaçao (CUR-AN) with Antillean (NL-AN), Surinam (NL-SUR), and Dutch (NL-NL) patients treated in The Netherlands. In total 2118 therapy-naive patients who started cART between January 2005 and August 2008 were included in the comparison. The CUR-AN patients initiated cART at a median CD4 cell count of 141 cells/mm(3) and 63% had counts below 200 cells/mm(3). Within 12 months of the start of cART 76% of the CUR-AN patients achieved viral suppression, defined as HIV-1 RNA plasma levels below 80 copies/ml. The percentage achieving viral suppression was higher in patients treated in The Netherlands (NL-AN = 87%, NL-SUR = 93%, and NL-NL = 96%). Lost to follow-up after 30 months of cART was 10% among CUR-AN patients and was higher than observed among patients treated in The Netherlands (NL-AN = 8%, NL-SUR = 3%, and NL-NL = 2%). A similar pattern was found for progression to AIDS and death (10% of CUR-AN vs. 5%, 6%, and 7% of NL-AN, NL-SUR, and NL-NL patients, respectively). Late start of cART and limited viral suppression after the start of cART determine the higher rate of disease progression to AIDS and death among Antillean patients treated in Curaçao. The high percentage of lost to follow-up may result in an underestimation of AIDS and AIDS-related death among HIV-1-infected Antilleans treated in Curaçao.

Optimizing Chronic HIV Care in the Dutch Caribbean: A Questionnaire Based Study on Experience and Perception of Healthcare Workers

“…A previous report showed that training in HIV/ AIDS in Curaçao that is aimed in part to increase efficacy of cART should at least be targeted toward the early identification and rapid referral of PLWH. In addition, it should also aim to improve adherence and compliance to therapy and retention of care as reported in several studies (7,8).…”

“…Care for patients (including cART provision) is provided by a single physician at the St Elisabeth Hospital. A recent report on cART outcome in Curaçao showed late clinical presentations, high rates of lost to follow-up and a low virological response in HIV-1 infected individuals (7). In order to integrate HIV care into the current PHC delivery system of Curaçao, task-shifting to different cadres of healthcare providers should seriously be considered.…”

The HIV Care Continuum in Curaçao

“…(1) However, in many Caribbean countries, late presentation continues to be a major obstacle for a successful outcome of cART, in part because of barriers for HIV testing. (2)(3)(4)(5)(6)(7)(8)(9) The continuum of HIV care is a dominant paradigm in engagement in HIV care. (10) The care continuum outlines sequential steps necessary for successful treatment of HIV-positive individuals focusing on the total population of people living with HIV, HIV diagnosis, linkage to care, retention in care, initiation of cART, and viral suppression (11) The Joint United Nations Programme on HIV/AIDS 90-90-90 by 2020 initiative was established with the goal of achieving virological suppression in 90% of all people receiving cART by the year 2020 (12), emphasizing the need for data on virological suppression per country against which national cART implementation programs can be assessed.…”

e-Monitoring of Asthma Therapy to Improve Compliance in children using a real-time medication monitoring system (RTMM): the e-MATIC study protocol

“…One randomized controlled trial for oral medication in adult diabetic patients has shown RTMM to be effective [39]. Also, preliminary results of a study in HIV-infected adults using RTMM show that patients receiving tailored text-message reminders improve adherence to antiretroviral therapy as well as rates of viral suppression [40]. The application of RTMM in children using inhalation medication has not been studied before and therefore needs further investigation.…”