Ten years after a free treatment program was introduced in Haiti’s capital, Port-au-Prince, two-thirds of the first 910 patients enrolled were still alive, the researchers said in a brief report published in The New England Journal of Medicine.
That is roughly the same 10-year mortality rate found among gay men in this country who started antiretroviral triple therapy when it was first started in the late 1990s, said Dr. Margaret L. McNairy, an internist at Weill Cornell and a report co-author.
Like Americans with H.I.V. then, many of the patients had blood counts of CD4 cells — a measure of immune system strength — below 100 and were “super-sick, nearly on their deathbeds” when they started treatment, she said. The death rates were highest in the study’s first six months “because we just got to those patients too late.”
All of the patients were recruited at a Port-au-Prince clinic run jointly by Weill Cornell and Gheskio, the French acronym for Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections.
(The clinic does not have the word “AIDS” in its name because it was founded in 1983, before the mysterious disease then killing Haitians, homosexuals, heroin users and hemophiliacs had even been described as acquired immune deficiency syndrome.)
By counting all the study participants still coming to the clinic or known to be in treatment elsewhere, and using three statistical models to estimate how many of the 111 missing patients were likely to be alive, the researchers calculated that between 63 percent and 71 percent of the original 910 had survived 10 years.
The clinic, supported primarily by American taxpayer dollars through theNational Institutes of Health and the President’s Emergency Plan for AIDS Relief, achieved this success despite Haiti’s political instability and grinding poverty, and sustained it through the 2010 earthquake and an ongoingcholera epidemic, Dr. McNairy said.
“This proves the long-term sustainability of efforts to provide AIDS treatment in developing nations,” she added.
By DONALD G. McNEIL Jr.