A South African study into antiretroviral treatment has found encouraging signs in long-term treatment outcomes.

The study looked at clinical, immunologic and virologic outcomes at large HIV/AIDS care clinics in resource-poor settings. These are usually poorly described beyond the first year of highly active antiretroviral treatment (HAART).

Global access to HAART has increased dramatically but in sub-Saharan Africa, where the majority of those in need are, people often remain untreated. South Africa has an estimated 5,000,000 people living with HIV and AIDS, and made a political commitment to include HAART in the public health treatment programs from April 2004.

South Africa now has the largest number of people receiving HAART in the world but the scale-up has been slower than anticipated, with a treatment gap that remains in excess of 500,000 people.

Researchers carried out a cohort study of patients who initiated HAART between April 1 2004 and March 13 2007, and followed up with them until April 2008 at the care clinics. They found good long-term retention and excellent clinical, immunologic and virologic outcomes.

A relatively high early mortality rate and high loss to follow up in the first months of treatment also demonstrated the need to strengthen strategies that promote early HIV diagnosis, early access to care and rapid initiation of HAART in very ill patients.

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