Effectiveness of Antiretroviral Therapy Among Patients Who Attend Public HIV Clinics in Rio de Janeiro, Brazil

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Abstract
Brazil provides antiretroviral therapy (ART) to HIV-infected persons free of charge. The objective of this study was to investigate factors associated with ART failure in patients receiving free ART in public clinics in Brazil. This is a cross-sectional study of adults taking ART for 6 to 24 months in 5 public clinics in Rio de Janeiro. Patients were interviewed and their charts were reviewed. The following definitions of response to therapy at 6 months were used: virologic responders (VR), ≥1 log reduction in plasma viral load (VL); immunologic responders (IR), increase of ≥50 CD4+ cells/mL; complete responders (CR), both VR and IR; and nonresponders (NR), neither VR nor IR. Of 211 patients enrolled, 173 (82%) were VR, IR, or CR and 38 (18%) were NR. Of the responders, 28 (13%) were IR, 32 (15%) were VR, and 113 (53%) were CR. In multivariate analysis, factors associated with NR were less than 80% adherence (OR = 8.6; 95% CI, 2.9–25.7), baseline CD4+ count (OR = 0.5 per 50 cells/mL; 95% CI, 0.2–1.1), interval between starting ART and first VL/CD4+ testing (OR = 1.4 for each month; 95% CI, 1.1–1.8), opportunistic disease after starting ART (OR = 6.8; 95% CI, 1.4–34.0), inability to read prescription (OR = 3.9; 95% CI, 1.4–10.9), not believing physician is knowledgeable about HIV (OR = 4.0; 95% CI, 1.1–15.0), not having a friend with HIV (OR = 6.1; 95% CI, 1.7–21.8), believing ART will make him/her ill (OR = 5.6; 95% CI, 1.7–18.8), and believing ART will delay HIV progression (OR = 0.001; 95% CI, 0.0–0.2). The proportion of patients responding to ART in Brazil was similar to reports from developed countries, suggesting that ART can be used successfully in developing countries. Variables related to adherence, knowledge, and perceptions about ART were associated with a lack of response to ART. These findings have important implications for developing nations that are considering increased access to ART.