Virologic Success in an Urban HIV Clinic: Outcome at 12 Months in Patients Who Were HAART Naïve

Abstract

Background: Randomized controlled trials with highly active antiretroviral therapy (HAART) have demonstrated over 70% virologic success rates, although patients in an inner city HIV setting likely have lower virologic success. Method: We studied the outcome of all treatment-naive patients beginning HAART in our urban clinic in Philadelphia, Pennsylvania. The primary outcome was virologic success at 12 months for all patients who were initiated on HAART. Secondary outcomes included virologic success at 12 months for only those who remained in care and the determination of which demographics influenced virologic success. Results: Between 2003 and 2005, 109 patients were initiated on HAART: 39% women, 79% African American, 17% Hispanic, median CD4+ count 120 cells/mm3, and HIV-1 RNA 4.9 log₁₀copies/mL. Twenty-two were lost to follow-up after HAART initiation. Of the 87 who remained in care, 41 maintained a HIV-1 RNA <400 copies/mL through 12 months on their initial HAART regimen. Emerging drug resistance was documented in 7 of 87 patients. NNRTI-based HAART was significantly associated with greater virologic failure due to emerging resistance compared to a PI-based regimen. Conclusion: Our retrospective study demonstrates the difficulties in administering successful HIV care to an urban population, and efforts to help patients overcome barriers to consistent medical care must be a priority.

Keywords:

• HAART
• HIV
• inner city
• virologic success