Assessing the association between changing NRTIs when initiating second-line ART and treatment outcomes

Julia K. Rohr, Prudence Ive, Charles Robert Horsburgh, Rebecca Berhanu, Christopher J. Hoffmann, Robin Wood, Andrew Boulle, Janet Giddy, Hans Prozesky, Michael Vinikoor, Mwanza Wa Mwanza, Gilles Wandeler, Mary Ann Davies, Matthew P. Fox

Research output: Contribution to journalArticlepeer-review

Abstract

Background: After first-line antiretroviral therapy failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line. Setting: We used clinical data from 6290 adult patients in South Africa and Zambia from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa cohort. Methods: We included patients who initiated on standard first-line antiretroviral therapy and had evidence of first-line failure. We used propensity score-adjusted Cox proportional-hazards models to evaluate the impact of change in NRTI on second-line failure compared with remaining on the same NRTI in second line. In South Africa, where viral load monitoring was available, treatment failure was defined as 2 consecutive viral loads >1000 copies/mL. In Zambia, it was defined as 2 consecutive CD4 counts <100 cells/mm 3 . Results: Among patients in South Africa initiated on zidovudine (AZT), the adjusted hazard ratio for second-line virologic failure was 0.25 (95% confidence interval: 0.11 to 0.57) for those switching to tenofovir (TDF) vs. remaining on AZT. Among patients in South Africa initiated on TDF, switching to AZT in second line was associated with reduced second-line failure (adjusted hazard ratio = 0.35 [95% confidence interval: 0.13 to 0.96]). In Zambia, where viral load monitoring was not available, results were less conclusive. Conclusions: Changing NRTI in second line was associated with better clinical outcomes in South Africa. Additional clinical trial research regarding second-line NRTI choices for patients initiated on TDF or with contraindications to specific NRTIs is needed.

Original languageEnglish (US)
Pages (from-to)413-416
Number of pages4
JournalJournal of acquired immune deficiency syndromes
Volume77
Issue number4
DOIs
StatePublished - 2018

Keywords

  • Antiretroviral therapy
  • NRTI
  • Nucleoside reverse transcriptase inhibitor
  • Secondline
  • South Africa
  • Zambia

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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