60% of HIV-Positive People in Africa Who Begin Antiretroviral Treatment Still Taking Drugs After Two Years, Study Says

About 60% of HIV-positive people in sub-Saharan Africa who begin treatment with antiretroviral drugs still are taking the drugs after two years, according to a study published Monday in PLoS Medicine, the AP/Los Angeles Times reports.

For the study -- led by Sydney Rosen, an assistant professor at Boston University's School of Public Health -- researchers examined 32 publications that reported on 74,192 people living with HIV/AIDS in 13 countries in sub-Saharan Africa between 2000 and 2007. The study found that 40% of the people who stopped treatment had died. The rest of the patients who stopped treatment missed scheduled medical appointments, failed to pick up medication or transferred to other clinics. In addition, a small percentage of people stopped treatment with antiretrovirals but continued to receive medical care at the same clinic where they began treatment (Cheng, AP/Los Angeles Times, 10/15).

According to the researchers, there are several possible reasons for the study's findings. Many patients' HIV was so far advanced when they began treatment that they died within a few months, the researchers found. Some people stopped treatment because they were unable to find transportation to clinics or were unable to afford antiretrovirals, according to the study. The study also found that success rates varied by program and country. One program in South Africa retained about 85% of people after two years, compared with a retention rate of 46% at a clinic in Uganda (BBC News, 10/16). The World Health Organization estimates that antiretroviral treatment programs in Western countries retain about 80% of people after two years.

Reaction
Although a 60% adherence rate is not "fabulous," the study could be considered a "success story" in terms of "deaths avoided and orphans avoided," Rosen said. Charlie Gilks, director of treatment at WHO's HIV/AIDS Department who was not involved with the study, said, "We clearly should be doing a lot better than 60%, but that is much more difficult than just identifying patients and getting the first pills into their mouths." Gilks said the data examined in the study are several years old, adding that he thinks an increased number of people now are adhering to their treatment regimens, although there is not evidence to confirm it.

According to the AP/Times, establishing smaller clinics outside urban areas might help increase treatment retention. "Once you get more than 1,000 to 1,500 patients, the services get congested and patient adherence rates go down," Gilles van Cutsem -- AIDS project coordinator for Medecins Sans Frontieres in Khayelitsha, South Africa, who was not involved with the study -- said. He added, "If we only treat patients in big clinics, then we are sacrificing the ones who are very sick who cannot walk very far."

Some experts also emphasized the importance of educating people on the significance of treatment and preventing the spread of HIV. Alison Grant, an HIV/AIDS epidemiologist at the London School of Hygiene and Tropical Medicine, said, "We need to help patients have a clear understanding of why they should take their antiretrovirals and what will happen to them if they don't." Daniel Halperin of the Harvard School of Public Health said that the "best treatment is prevention." He added, "If we can prevent this epidemic, then that will solve a lot of the treatment issues eventually. ... Otherwise, we may not be able to keep up with so many patients" (AP/Los Angeles Times, 10/15).

The study is available online.