Abstract

Rapid expansion of the national antiretroviral treatment program in Thailand: program outcomes and patient survival, 2000-2005

Ningsanond P.¹, Lertpiriyasuwat C.¹, McConnell M.², Chasombat S.¹, Siangphoe U.², Mock P.², Fox K.², Thanprasertsuk S.¹

¹Bureau of AIDS, TB, and STIs, Department of Disease Control, MOPH, Thailand, Nonthaburi, Thailand, ²Global AIDS Program, Thailand MOPH-US CDC Collaboration, Thailand, Nonthaburi, Thailand

Background: Antiretroviral treatment (ART) is increasingly available for HIV-infected persons in resource-limited settings. In Thailand, the Ministry of Public Health initiated a national ART program in 2000 and rapidly expanded access across the country. Thai guidelines recommend initiating antiretrovirals at CD4 count <200 cells/mm3 or symptomatic HIV with CD4 count <250 cells/mm3. The first-line ART regimen includes stavudine, lamivudine, nevirapine.

Methods: Demographic and clinical data were reported by 746 (98%) of 756 participating hospitals. To allow for reporting delays, data analysis included patient visits through March 2005. Lost to follow-up was defined as >9 months without a visit. Survival probability was estimated with Kaplan-Meier and Cox regression analyses.

Results: Data were available from 42,139 patients enrolled January 2000-March 2005; 82.8% enrolled in 2003-2004. Of enrollees, 52.2% were male, and median age was 34.1 years. At baseline, 49.3% had clinical AIDS; the median CD4 count was 46 cells/mm3 (inter-quartile range=14-131). Initial treatment included nevirapine- (90.2%) and efavirenz- (8.1%) based regimens. At follow-up, 85.1% of patients remained on treatment, 2.6% stopped antiretrovirals, 5.4% were lost to follow-up, 6.2% died due to AIDS, and 0.7% died not due to AIDS [crude AIDS death rate = 0.007 deaths/patient-month]. The risk of AIDS death was significantly increased with lower baseline CD4 counts. Among 13,192 patients with 12 months of follow-up, 89.9% remained on the baseline regimen.

Conclusions: In Thailand, there has been rapid scale-up of national ART. Early ART initiation was associated with reduced mortality; program efforts should promote early identification of HIV infection and early access to treatment.

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