Four years of experience with antiretroviral therapy in adult patients in Karachi, Sindh, Pakistan

The Sindh AIDS Control Program (SACP) in Pakistan began dispensing combination antiretroviral therapy (ART) in May 2006 in Karachi. This study aimed to assess the management and outcomes of ART-treated patients. Data were extracted from medical records of adult patients registered with the SACP who received ART between May 2006 and May 2010. In total, 300 patients received ART, of whom 77.7% were men. The median CD4 cell count at the time of joining the SACP was 130 cells/mm3. ART was nevirapine-based in 69.1% of cases and was correctly prescribed in 97.3%. Of 257 patients who received ≥1 month of ART, >90% were regular with their medications and appointments. Of the 300 patients, 70 (23.3%) had HIV-related deaths and 4 (1.3%) had non-HIV-related deaths, whereas 32 (10.7%) transferred out and 16 (5.3%) stopped attending the clinic and could not be traced. Estimated survival in the first 6 months stratified by initial CD4 lymphocyte count ≥50 cells/mm3 and <50 cells/mm3 was 85.8% (95% CI 80.8-90.0%) and 52.2% (95% CI 40.9-63.1%), respectively. Viral suppression was achieved in 95.4% of those who survived beyond 3 months of starting ART. ART can be managed adequately with excellent patient adherence and satisfactory clinical outcomes in a resource-limited setting.