A clinical assessment of antiretroviral-treated patients Referred from the private sector to the South African government antiretroviral (ARV) programme: a retrospective analysis

Objectives. A comparison of the effects of highly active antiretroviral therapy (HAART) on the immunological, virological and clinical status of two groups of patients in the South African government antiretroviral (ARV) programme in KwaZulu-Natal, viz. patients previously treated with ARVs in the private sector and then entering the government programme (private group), and ARV-naïve patients entering the programme directly (government group). Methods. A retrospective, cohort study was performed by reviewing records of 58 former private sector patients and 98 patients initiated on ARV treatment in the government sector. Treatment regimens, CD4 cell counts, viral loads and regimen modifications were analysed. Results. The study found that use of various classes of ARV drugs varied between the private sector and the government sector. Median distribution of CD4 cell count increased from 158.5 to 419 cells/μl for the private group (42 patients (72.4%)) and from 101 to 358 cells/μl for the government group (95 patients (96.9%)), over an average time span ranging from 29 to 30 months. Median viral load decreased in the private group (29 patients (50%)) and the government group (66 patients (67.3%)) to approximately 3.22 log copies/ml (25 copies/ml) over an average time span ranging from 27 to 29 months. The rate of change of CD4 cell count (p=0.47) and viral load (p=0.097) between the two groups was not significantly different. Conclusion. This study showed that even for patients with prior experience with ARVs, virological and immunological success is still achievable with the use of standardised HAART regimens in the government programme