HIV infections in the Philippines have climbed >35-fold in the last decade. The impact of widely available free antiretrovirals (ARVs), and earlier initiation of treatment has not been conclusively demonstrated in this country. We looked at temporal trends and predictors of mortality to better characterize the epidemic in the Philippines, and provide clinical evidence of the beneficial effect of early and sustained ARV therapy.
Following institutional board review approval, we retrospectively reviewed 1,022 charts of patients aged ≥18 years at our HIV clinic at the Philippine General Hospital, one of the largest tertiary referral centers in the country. We divided patients into two groups (group 1 1992 to 2006 N=132; group 2 2007 to 2013 N=892) to explore temporal trends coinciding with the widespread rollout of ARVs. Multivariate analysis on the entire cohort was done to look at factors associated with mortality.
Age at diagnosis was significantly younger for group 2 compared to group 1 (mean=29 vs. 35 years, p<0.0001). The proportion of males (96% vs. 74%), patients identifying as homosexual (50% vs. 14%) or bisexual (37 vs. 8%), sex with multiple partners (93% vs. 33%), and initial WHO stage 1 diagnosis (45% vs. 14%) were all significantly higher in group 2 (p<0.0001). Median initial CD4 (193 vs. 220 cells/µL) was not significantly different between groups. The ARV regimen most used in group 1 was zidovudine, lamivudine, and nevirapine (65%), whereas tenofovir, lamivudine and efavirenz (40%) was the most common in group 2.
Factors associated with mortality for the entire cohort were a CD4 count at diagnosis <200 cells/µL (OR 5.98, 95%CI 2.26-15.80, p<0.0001); the use of efavirenz-based ARV (OR 0.23, 95%CI 0.11-0.25, p<0.0001) and use of nevirapine-based ARV (OR 0.34, 95%CI 0.15-0.76, p<0.0001). Not enough patients were on a protease-inhibitor regimen for adequate analysis.
The epidemiology of HIV in the Philippines has changed, with increasing proportions of MSM with multiple sexual partners making up new cases. Patients are being diagnosed at younger ages with few symptoms, although CD4 counts did not differ significantly. Mortality is higher in patients diagnosed at lower CD4 counts, and ARVs have a significant impact on survival in Filipinos living with HIV.
E. M. Salvana,
M. Alejandria, None
R. Destura, None
P. Ching, None
R. Duque, None
R. Duque, None
C. Amor, None
O. Sison, None
J. Lim, None