Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113869

Maria Isabel Tavarez, MD¹, Talía Flores, MD², Arelis Batista, MD³, Jose Gonzalez Carpio, MD², Virginia Salcedo, MPH¹, Consuelo Beck-Sague, MD⁴, and Toye Brewer, MD⁵. (1) Unidad Central de Atención Integral, Secretaría de Salud Pública y Asistencia Social, Programa Nacional de Atención Integral a Personas que Viven con VIH/SIDA, Av. San Cristobal esq. Tiradentes, Santo Dominigo, Dominican Republic, 809-541-3121, isabelmaria06@yahoo.es, (2) Centro de Dia, Hospital Luis E Aybar, Calle Federico Velásquez # 1 Urb. Maria Auxiliadora, Santo Domingo, Dominican Republic, (3) Clinica Rural Sabana Perdida Lotes y Servicio, Calle 12 esq. Flor del Sol # 35, lotes y servicios, Santo Domingo Norte, Dominican Republic, (4) International Family AIDS Program, Columbia University, Casa de Paz Complejo Micaeliano, Calle Gastón F. Deligne # 168 esq. Gregorio Luperón, La Romana, Dominican Republic, (5) Mailman School of Public Health, International Center for AIDS Care and Treatment Programs-, Columbia University, Torre Piantini, Esq. Gustavo Mejia Ricart con Abraham Lincoln, Ofc 405, Santo Domingo, Dominican Republic

Background: HIV is an important cause of death among 18-44 year-olds in the DR, the highest HIV-prevalence-country in the Spanish-speaking world. In 2004, the number of persons receiving HAART in the DR soared due to distribution of free antiretrovirals by the Dominican government. Through January 14, 2005,-HAART was initiated in 1,053 patients (928 adults [88.1%], 125 children [11.9%]). Methods: Data were abstracted from medical records of 184 (20%) adult patients initiating HAART in three of 16 facilities and analyzed using Chi-square or ANOVA. Results: At HAART initiation, adults ranged in age from 21-78 years (median=38); 95 (51.6%) were female. CD4+T-cell counts ranged from 2-464 (median=94), and were lower among men than women (median=73 vs. 98, p=.06). Most patients' initial regimen (105 [57%]) consisted of generic zidovudine-lamivudine and nevirapine formulations; 11.9% received stavudine instead of zidovudine due to anemia. Efavirenz in combination with other antiretrovirals was prescribed initially to 36 (19.6%) patients, largely because of hepatic dysfunction. Women were less likely to receive efavirenz-containing regimens than men (10.5% vs. 29.9%; p=.001). Twelve adverse reactions, one fatal, were reported in 11 (6.4%) of patients; 11 were nevirapine-related hepatic or dermatologic reactions. Thirty patients (16.3%) receiving HAART were known to have died by January 2005. Initial median CD4-count of those who died was lower than that of patients still alive in 2005 (30 versus 99; p=.007). Marked clinical improvement was noted in most patients within weeks of HAART initiation. Conclusions: HAART in adults, despite high adverse reaction rate, was associated with considerable improvement.

Learning Objectives: At the conclusion of this session, participants will be able to

• Describe characteristics of the first persons receiving highly active antiretroviral therapy (HAART) in the Dominican Republic through the public health program. 2. Discuss hypotheses to explain striking gender differences in immune function at HAART initiation and in use of selected antiretrovirals 3. Estimate the incidence of adverse reactions to HAART and mortality in HAART patients in this setting 4. Assess the contribution of HAART to well-being of persons living with HIV/AIDS in the Dominican Republic

Keywords: Antiretroviral Combination Therapy, Developing Countries

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.