Short-Term Effectiveness and Safety of Third-Line Antiretroviral Regimens Among Patients in Western India

Sn, Pujari; Makane, Abhimanyu; Lodha, Abhay; Bele,; Joshi, Kedar

doi:10.1097/qai.0b013e3182a6104a

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Third-line ART as the last line of defence against HIV was highly effective in this cohort, with over 90% retention and viral suppression at 12 months post-switching, similar to other studies [26,27]. High level of resistance against PIs, in excess of the lower levels (8–25%) documented elsewhere [31–34] but similar to those documented specifically among second-line ART failure cases (58–73%) were noted [27,28]. The triple class resistance to NRTIs, NNRTIS and PIs in more than half of the cases undergoing genotyping is worrying.…”

Section: Discussionsupporting

confidence: 88%

Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India

Gill¹,

Bergh²,

Kyaw³

et al. 2019

PLoS ONE

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BackgroundHIV programs are increasingly confronted with failing antiretroviral therapy (ART), including second-line regimens. WHO has provided guidelines on switching to third-line ART. In a Médecins Sans Frontières clinic in Mumbai, India, receiving referred presumptive second-line ART failure cases, an evidence-based protocol consisting of viral load (VL) testing, enhanced adherence counselling (EAC) and genotype for switching was implemented.ObjectiveTo document the outcome and genotype of presumptive second-line ART failure cases switched to third-line or maintained on second-line ART.DesignRetrospective cohort study of patients referred between January 2011 and September 2017.ResultsThe cases (n = 120) were complex with median 9.2 years of ART exposure, poor adherence at baseline, and exposure to multiple ART regimens other than recommended by WHO. Out of 90 evaluated cases, 39(43%) were maintained on second-line ART. Forty-nine (54%) were ever switched to third-line ART. Twelve months virological suppression was 72% in the second-line and 93% in the third-line ART cohort, while retention in care was 80% and 94% respectively. Genotyping showed 62% resistance for PIs, and 52% triple class resistance to NRTIs, NNRTIs and PIs. Resistance was noted for the new class of integrase inhibitors, and for different drugs without any documented previous exposure to the same drug.ConclusionAdopting WHO guidelines on switching ART regimens and provision of EAC can prevent unnecessary switching/exposure to third-line ART regimens. Genotyping is urgently required in national HIV programs, which currently use only the exposure history of patients for switching to third-line ART regimens.

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Section: Discussionsupporting

confidence: 88%

Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India

Gill¹,

Bergh²,

Kyaw³

et al. 2019

PLoS ONE

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“…The lack of access to affordable antiretroviral drugs that can be used in robust combinations is another barrier to management of those failing second-line ART. National ART programmes need to be prepared to offer third-line ART (18), and they should already start preparing by making supplies of darunavir and raltegravir accessible. Furthermore, management of patients needing third-line ART can be complicated and may require palliative care (19).…”

Section: Discussionmentioning

confidence: 99%

Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India

Khan¹,

Das²,

Andries³

et al. 2014

Global Health Action

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BackgroundThere are limited data on the failure of second-line antiretroviral therapy (ART) and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Médecins Sans Frontières (MSF) HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care.ObjectiveTo describe the experiences and programmatic challenges during management of suspected second-line ART failure and third-line ART therapy for patients living with HIV, including the use of HIV viral load (VL) testing.DesignThis was a retrospective, observational cohort study of patients with suspected second-line ART treatment failure, who were followed for at least 12 months between January 2011 and March 2014.ResultsA total of 47 patients with suspected second-line failure met the inclusion criteria during the study period. Twenty-nine of them (62%) responded to enhanced adherence support, had a subsequent undetectable VL after a median duration of 3 months and remained on second-line ART. The other 18 patients had to be initiated on a third-line ART regimen, which consisted of darunavir–ritonavir, raltegravir, and one or more appropriate nucleoside or nucleotide reverse transcriptase inhibitors, based on the results of HIV genotype testing. Of the 13 patients for whom follow-up VL results were available, 11 achieved virological suppression after a median duration of 3 months on third-line ART (interquartile range: 2.5–3.0). No serious treatment-related adverse events were recorded.ConclusionsWith intensive counselling and adherence support in those suspected of failing second-line ART, unnecessary switching to more expensive third-line ART can be averted in the majority of cases. However, there is an increasing need for access to third-line ART medications such as darunavir and raltegravir, for which national ART programmes should be prepared. The cost of such medications and inadequate access to VL monitoring and HIV genotype testing are currently major barriers to optimal management of patients failing second-line ART.

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“…Despite challenges, achievements in battling HIV in India are recognized, and are significantly enhanced by recent governmental commitments to implement test and treat, routine VL monitoring, and third-line ART [50].…”

Section: Indiamentioning

confidence: 99%

Regional Challenges in the Prevention of Human Immunodeficiency Virus Drug Resistance

Godfrey

Bobkova

Boucher

et al. 2017

The Journal of Infectious Diseases

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Short-Term Effectiveness and Safety of Third-Line Antiretroviral Regimens Among Patients in Western India

Cited by 3 publications

References 12 publications

Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India

Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India

Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India

Regional Challenges in the Prevention of Human Immunodeficiency Virus Drug Resistance

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