[Long-term impact of antiretroviral therapy in Africa: current knowledge]

Abstract

By the end of 2013, 11 million PLHIV were taking ARVs in Africa; application of the WHO recommendation to initiate treatment earlier (at CD4 count of 500 cells/mm3 or less) should further increase this number. Currently, twothirds of patients in Africa have been on treatment for less than five years, and less than 10% have received treatment for eight years or more. Given the historical perspective is in its early stages, the long-term impact of ARV therapy is still unclear. This article reviews the knowledge gained over the period marking the first ten years of implementation of the universal access strategy (2003-2013) in Africa, through a review of the literature documenting the long-term consequence of ARV treatment, focusing on medical care for adults with an emphasis on the patient-centered approach. The goal is to understand the interrelationships between biological and social factors and individual and collective aspects that affect the lives of PLHIV and determine the impacts of ARV treatment over the long term. The biomedical and social factors are addressed successively, based on the most significant results. Key knowledge on the long-term outcomes for PLHIVon ARV treatment offers vital information on the necessary conditions and adaptations for care systems needed to ensure the benefits of treatment endure over time.