Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries

CONTEXT Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. OBJECTIVES To...

Full description

Saved in:
Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2010-07, Vol.304 (3), p.303-312
Main Authors: Pujades-Rodríguez, Mar, Balkan, Suna, Arnould, Line, Brinkhof, Martin A. W, Calmy, Alexandra, AIDS Working Group of MSF, for the
Format: Article
Language:English
Subjects:
Adolescent
Adult
Africa - epidemiology
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Asia - epidemiology
Biological and medical sciences
CD4 Lymphocyte Count
Cohort Studies
Developing Countries
Drug therapy
Epidemiology
Female
General aspects
Health Services Accessibility
HIV
HIV Infections - drug therapy
HIV Infections - mortality
Human immunodeficiency virus
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Patient Compliance
Patients
Public health. Hygiene
Public health. Hygiene-occupational medicine
Treatment Failure
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Young Adult
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:CONTEXT Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. OBJECTIVES To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. DESIGN, SETTING, AND PARTICIPANTS Multicohort study of 632 patients >14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. MAIN OUTCOME MEASURES Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. RESULTS The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2010.980