Outcomes of Second Combination Antiretroviral Therapy Regimens Among HIV-Infected Persons in Clinical Care: A Multicenter Cohort Study

Napravnik, Sonia; Eron, Joseph J.; Juday, Timothy; Uy, Jonathan; Moore, Richard D.

doi:10.1089/aid.2012.0210

Cited by 10 publications

(10 citation statements)

References 25 publications

(26 reference statements)

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“…In addition, the incidence of second-line failure was 3.4 times higher for those with a detectable viral load and the probabilities of failure at 12, 24 and 36 months were consistently higher for this group. Taken together, these results clearly point to differences in outcomes as a function of an individual’s HIV RNA at start of second-line cART which is in agreement with the findings from a multicenter study with a similar design [ 20 ].…”

Section: Discussionsupporting

confidence: 88%

“…Indeed, non-adherence to therapy has been shown to be one of the strongest predictors of cART failure [ 21 ],[ 22 ]. In this group, the median time from second-line cART to failure was 113 months, two-fold higher than the 50 months median time found in a multicenter study from the United States [ 20 ]. Differences in socio-demographic characteristics, adherence pattern and regimen tolerability may explain the better outcomes shown in our study.…”

Section: Discussionmentioning

confidence: 64%

“…Differences in socio-demographic characteristics, adherence pattern and regimen tolerability may explain the better outcomes shown in our study. Also, in our cohort, only 2% were IDUs, while up to 24.2% were IDUs in the US cohort [ 20 ]. Moreover, our study participants initiated cART on or after the year 2000 when friendlier regimens were increasingly available.…”

Section: Discussionmentioning

confidence: 97%

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Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil

et al. 2014

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BackgroundWorld-wide, the notable expansion of HIV/AIDS treatment programs in resource-limited settings has lead to an increasing number of patients in need of second-line cART. To adequately address and prepare for this scenario, critical assessments of the outcomes of second-line cART are particularly relevant in settings where monitoring strategies may be inadequate. We evaluated virologic outcomes of second-line combination antiretroviral therapy (cART) among HIV-infected individuals from Brazil.MethodsThis study was conducted at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, at Rio de Janeiro, Brazio. For this study we included all patients who started first-line and second-line cART between 2000 and 2013. Second-line cART required a switch in the anchor drug of first-line cART. We evaluated time from second-line start to virologic failure and factors associated with increased risk of failure using multivariable Cox proportional hazards regression models.ResultsAmong the 1,311 patients who started first-line cART a total of 386 patients (29.5%) initiated second-line cART, out of which 35.0% and 60.6% switched from their first-line to their second-line cART when their HIV RNA was undetectable and after documented virologic failure, respectively. At second line cART initiation, median age was 38 years [interquartile range (IQR): 31-45years]. Median CD4 count was significantly different for patients starting second-line cART undetectable [412 cells/mm3 (IQR: 240-617)] compared to those starting second-line cART after documented virologic failure [230 cells/mm3 (IQR: 118-322.5)] (p < 0.01). Median time from second-line cART initiation to failure was also significantly different for patients starting second-line cART undetectable compared to those who with documented virologic failure (log-rank test p < 0.01). Multivariable Cox models showed that younger age, lower education, and HIV RNA level were independently associated with an increased hazard of second-line failure among those with documented virologic failure at start of second-line cART.ConclusionsWe have shown that in a middle-income country with universal access to cART, having a detectable HIV RNA at the start of second-line cART as well as younger age and lower education negatively impact second-line outcomes. Our findings could guide HIV treatment efforts as to which strategies would help maximize the durability of these regimens.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0699-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 97%

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Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil

et al. 2014

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“…Second, data on prior treatment history and ARV resistance were unavailable and thus, we could not restrict this analysis only to patients who were ARV naïve and did not have transmitted ARV resistance. As has been shown previously, patients on second and third line regimens are likely to have lower levels of viral suppression, lower adherence and more side effects [1,37]. Moreover, we did not have information on all factors that might inform a clinician's decision to prescribe an initial regimen, such as HLAB5701 testing or initial viral load.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Patterns of Antiretroviral Therapy Prescription in the United States

Tie¹,

Skarbinski²,

Qin³

et al. 2018

TOAIDJ

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Background: The use of Antiretroviral Therapy (ART) in HIV-infected persons has proven to be effective in the reduction of risk of disease progression and prevention of HIV transmission. Objective: U.S. Antiretroviral Therapy (ART) guidelines specify recommended initial, alternative initial, and not-recommended regimens, but data on ART prescribing practices and real-world effectiveness are sparse. Methods: Nationally representative annual cross sectional survey of HIV-infected adults receiving medical care in the United States, 2009-2012 data cycles. Using data from 18,095 participants, we assessed percentages prescribed ART regimens based on medical record documentation and the associations between ART regimens and viral suppression (most recent viral load test <200 copies/ml in past year) and ART-related side effects. Results: Among HIV-infected adults receiving medical care in the United States, 91.8% were prescribed ART; median time since ART initiation to interview date was 9.8 years. The percentage prescribed ART was significantly higher in 2012 compared to 2009 (92.7% vs 88.7%; p < 0.001). Of those prescribed ART, 51.6% were prescribed recommended initial regimens, 6.1% alternative initial regimens, 29.0% not-recommended as initial regimens, and 13.4% other regimens. Overall, 79.5% achieved viral suppression and 15.7% reported side effects. Of those prescribed ART and initiated ART in the past year, 80.5% were prescribed recommended initial regimens. Conclusion: Among persons prescribed ART, the majority were prescribed recommended initial regimens. Monitoring of ART use should be continued to provide ongoing assessments of ART effectiveness and tolerability in the United States.

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“…A high HIV RNA at baseline or start of second-line ART has been demonstrated by others as a strong independent predictor of second-line failure [ 30 – 33 ]. In addition to a high burden of virus at the start of second-line ART, here we report that patients who never reach virologic suppression while on second-line are at increased risk of switch to third-line (aHR 3.37 95% CI 1.47–7.73).…”

Section: Discussionmentioning

confidence: 99%

Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg, South Africa

et al. 2018

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BackgroundWhile efficacy data exist, there are limited data on the outcomes of patients on third-line antiretroviral therapy (ART) in sub-Saharan Africa in actual practice. Being able to identify predictors of switch to third-line ART will be essential for planning for future need. We identify predictors of switch to third-line ART among patients with significant viraemia on a protease inhibitor (PI)-based second-line ART regimen. Additionally, we describe characteristics of all patients on third-line at a large public sector HIV clinic and present their early outcomes.MethodsRetrospective analysis of adults (≥ 18 years) on a PI-based second-line ART regimen at Themba Lethu Clinic, Johannesburg, South Africa as of 01 August 2012, when third-line treatment became available in South Africa, with significant viraemia on second-line ART (defined as at least one viral load ≥ 1000 copies/mL on second-line ART after 01 August 2012) to identify predictors of switch to third-line (determined by genotype resistance testing). Third-line ART was defined as a regimen containing etravirine, raltegravir or ritonavir boosted darunavir, between August 2012 and January 2016. To assess predictors of switch to third-line ART we used Cox proportional hazards regression among those with significant viraemia on second-line ART after 01 August 2012. Then among all patients on third-line ART we describe viral load suppression, defined as a viral load < 400 copies/mL, after starting third-line ART.ResultsAmong 719 patients in care and on second-line ART as of August 2012 (with at least one viral load ≥ 1000 copies/mL after 01 August 2012), 36 (5.0% over a median time of 54 months) switched to third-line. Time on second-line therapy (≥ 96 vs. < 96 weeks) (adjusted Hazard Ratio (aHR): 2.53 95% CI 1.03–6.22) and never reaching virologic suppression while on second-line ART (aHR: 3.37 95% CI 1.47–7.73) were identified as predictors of switch. In a separate cohort of patients on third-line ART, 78.3% (47/60) and 83.3% (35/42) of those in care and with a viral load suppressed their viral load at 6 and 12 months, respectively.ConclusionsOur results show that the need for third-line is low (5%), but that patients’ who switch to third-line ART have good early treatment outcomes and are able to suppress their viral load. Adherence counselling and resistance testing should be prioritized for patients that are at risk of failure, in particular those who never suppress on second-line and those who have been on PI-based regimen for extended periods.Electronic supplementary materialThe online version of this article (10.1186/s12981-018-0196-9) contains supplementary material, which is available to authorized users.

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Outcomes of Second Combination Antiretroviral Therapy Regimens Among HIV-Infected Persons in Clinical Care: A Multicenter Cohort Study

Cited by 10 publications

References 25 publications

Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil

Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil

Prevalence and Patterns of Antiretroviral Therapy Prescription in the United States

Predictors of switch to and early outcomes on third-line antiretroviral therapy at a large public-sector clinic in Johannesburg, South Africa

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