The Chilean AIDS Cohort ChiAC: Impact of an expanded access program to HAART in survival and risk factors for mortality

1. The Chilean AIDS Cohort (ChiAC): Impact of an expanded access program to HAART in survival and risk factors for mortality in a treatment na�ve population Beltr�n C., Wolff M. , V�squez P., Berna L., Carre�o J., Toro C., Chah�n C. Chilean AIDS Study Group, Santiago, Chile

2. This work has been financed by grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the National Fund for Health Research (FONIS)

3. Expanded access program (EAP) to AIDS therapy is being implemented worldwide. Chile has such a program since 2001 and as of 7/2004 ~4,452 patients had begun HAART; 100% coverage was reached in late 2003 in the Public Health System (PHS). By 7/2005 ~ 6,000 are in HAART under EAP A new law guaranties universal access regardless of the health care system in charge of the assistance

5. The Chilean AIDS Cohort: ChiAC A network of health care providers from AIDS care centers from the PHS contributes to homogeneous follow up of these patients in an observational prospective cohort (ChiAC). Information is exchanged through internet By 7/2004 CHiAC-1 had enrolled 4,365 pts (98% of all those under HAART in the PHS at that time) from 29/32 centers

6. Chilean AIDS Cohort: ChiAC

7. Objective To assess the survival impact of the Expanded Access Program to HAART in a treatment na�ve (Tx nv) population from a national cohort and to evaluate baseline characteristics as risk factors for mortality. 

8. Methods Prospective follow up and review of ChiAC database. 

9. Population composition

10. Baseline AIDS defining events (ADE) rate

11. Treatment na�ve patients Baseline information

12. Treatment regimens in 2,103 treatment na�ve patients Backbone therapy: AZT + 3TC: 83.9% 3TC + d4T or ddI or abacavir: 10.1%

13. Results Median follow up time: 784 days 322 patients had endpoints: 143 (6.8%) died (~2/3 of them in the first 6 months) 179 (8.5%) discontinued initial therapy By 12/31/2004: 1,781 patients had completed 6 months of therapy 1,685 patients had completed 12 months of therapy 976 patients had completed 24 months of therapy 1,341 (of those still in treatment remained on the initial regimen

15. Survival of treatment-na�ve patients

16. Global mortality according to baseline CDC stage

17. Global mortality according to baseline immune status

18. Conclusions Expanded access program to state of the art antiretroviral therapy in a middle-income country has been successful in terms of survival in an advanced-disease population. Significant higher mortality was observed only in clinically severe disease (AIDS) or severe immunodepression. A national cohort model may contribute both, to the evaluation of such a program and to its overall success

19. Our sincere and deep recognition to the members of the Chilean AIDS Study Group Carlos Gallo, Roxana Galvez, David Wachter, Patricia Sarabia, Marcela de Andraca, Patricia Pavez, Patricia Carrasco,Lorena Berna, Carmen Aguayo, Marisol Ayala, Viviana Turi, Luis Montes, Eduardo Hermosilla, Gladys Varela, M. Eugenia Madariaga, Erna Ripoll, Elizabeth Barthel, M. In�s S�nchez, M. Teresa de Mateo, Werner Jensen, Rodrigo Ahumada, Alvaro Covarrubias, Luis Bavestrello, Sylvia G�mez, A. Burdiles, P. Rodas, Katty Z��iga, Marcelo Wolff (coordinator), Rebeca Northland, Teresa Bidart, Jeanette Dabanch, Claudia Bustamante, Patricia Alvarez, Ingrid Flores, Patricia V�squez, Marisol Bustos, Claudia Ledesma, Juan Ballesteros, Alexis Diomedi, Rinna Ortega, Jeannette Sobarzo, Jorge P�rez, Mart�n Lasso, Ana M. Fern�ndez, Aurora Gar�n, Enna Zunino, Laura Bahamondes, Patricia Olea, Luc�a Aguad, M. Moreno, Cristian Montenegro, C. Vald�s, Margarita Enberg, J. L�pez de Maturana, R. Pizarro, M. Quezada, Gregorio Ram�rez, Johanna Bravo, Erika Molina, Carlos Beltr�n (coordinator), Ricardo Morales, David Gallardo, J.M.Arancibia, Amalia Adasme, Miguel Valenzuela, Johanna Huerta, Diana Yanine, Silvia Arredondo,Manuel Amigo, Mauricio Maturana, M. Ang�lica Olivares, Luis Uribe, Eugenia Rodr�guez, Ricardo V�squez, Eva Woldarsky, Elizabeth Daube, Rodrigo Blamey, M. Eugenia Cancino, M. Elena Novoa, Jos� Carre�o, M. Isabel Mendoza, Carolina Chah�n, Claudia Molina, Mario Calvo, M�nica Hering, Alicia Rebolledo, Jorge Mardones, Sara Villalobos, Iv�n Becerra, Ana M. S�ez, Carmen Toro, Luc�a Atala, Stanko Karelovic and Tatiana Navarro. Alejandra Valdovinos, Ang�lica Carrasco, Luis Villarroel and Omar Morales (staff)

20. Our sincere and deep recognition to the members of the Chilean AIDS Study Group

21. Our major recognition and appreciation To the 4,365 patients in the 5,000 kilometer long network Thanks