Effect of therapy switch on time to second-line antiretroviral treatment failure in HIV-infected patients

Abstract

BackgroundSwitch from first line antiretroviral therapy (ART) to second-line ART is common in clinical practice. However, there is limited knowledge of to which extent different reason for therapy switch are associated with differences in long-term consequences and sustainability of the second line ART.Material and methodsData from 869 patients with 14601 clinical visits between 1999–2014 were derived from the national cohort database. Reason for therapy switch and viral load (VL) levels at first-line ART failure were compared with regard to outcome of second line ART. Using the Laplace regression model we analyzed the median, 10th, 20th, 30th and 40th percentile of time to viral failure (VF).ResultsMost patients (n = 495; 57.0%) switched from first-line to second-line ART without VF. Patients switching due to detectable VL with (n = 124; 14.2%) or without drug resistance mutations (DRM) (n = 250; 28.8%) experienced VF to their second line regimen sooner (median time, years: 3.43 (95% CI 2.90–3.96) and 3.20 (95% 2.65–3.75), respectively) compared with those who switched without VF (4.53 years). Furthermore level of VL at first-line ART failure had a significant impact on failure of second-line ART starting after 2.5 years of second-line ART.ConclusionsIn the context of life-long therapy, a median time on second line ART of 4.53 years for these patients is short. To prolong time on second-line ART, further studies are needed on the reasons for therapy changes. Additionally patients with a high VL at first-line VF should be more frequently monitored the period after the therapy switch.

Rate of Viral Re-Suppression and Retention To Care Among HIV Infected Patients on Second Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

“…Being ambulatory, bedridden and lower CD4 cell count at therapy switch had an increased risk of lost to follow up and death. This nding was consistent with the studies done in Ethiopia on patients on rst line therapy (14,15,17,27,32). Hence, accessing routine viral load monitoring for early diagnosis of treatment failure will increase the probability of patient retention on care, instead of waiting until immunological failure or clinical advancement.…”

“…Having high viral load at the commencement of second line antiretroviral therapy is inversely related to viral resuppression. This nding is also supported by many studies (14,16,17,(25)(26)(27)(28). Hence, switching to second line therapy may not be a warranty for viral re-suppression for patients with high viral set point.…”

Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

“…This finding is also supported by many studies. 7 , 9 , 10 , 13 , 25 , 32 , 33 Hence, switching to second-line therapy may not be a warranty for viral re-suppression for patients with high viral set point. It requires further close monitoring and strengthening of the implementation of enhanced adherence counseling for such type clients.…”

“…This finding was consistent with the studies done in Ethiopia on patients on first-line therapy. 8 , 10 , 25 , 32 , 37 Hence, accessing routine viral load monitoring for early diagnosis of treatment failure will increase the probability of patient retention on care, instead of waiting until immunological failure or clinical advancement. This association may be explained by poor immunological and clinical condition can easily lead to drug intolerance as well as poor drug compliance and this may further contribute poor treatment outcomes and failed to retained on care.…”