Treatment outcomes of over 1000 patients on second-line, protease inhibitor-based antiretroviral therapy from four public-sector HIV treatment facilities across Johannesburg, South Africa

Kate Shearer, Denise Evans, Faith Moyo, Julia K. Rohr, Rebecca Berhanu, Liudmyla Van Den Berg, Lawrence Long, Ian Sanne, Matthew P. Fox

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To report predictors of outcomes of second-line ART for HIV treatment in a resource-limited setting. Methods: All adult ART-naïve patients who initiated standard first-line treatment between April 2004 and February 2012 at four public-sector health facilities in Johannesburg, South Africa, experienced virologic failure and initiated standard second-line therapy were included. We assessed predictors of attrition (death and loss to follow-up [≥3 months late for a scheduled visit]) using Cox proportional hazards regression and predictors of virologic suppression (viral load <400 copies/ml ≥3 months after switch) using modified Poisson regression with robust error estimation at 1 year and ever after second-line ART initiation. Results: A total of 1236 patients switched to second-line treatment in a median (IQR) of 1.9 (0.9-4.6) months after first-line virologic failure. Approximately 13% and 45% of patients were no longer in care at 1 year and at the end of follow-up, respectively. Patients with low CD4 counts (<50 vs. ≥200, aHR: 1.85; 95% CI: 1.03–3.32) at second-line switch were at greater risk for attrition by the end of follow-up. About 75% of patients suppressed by 1 year, and 85% had ever suppressed by the end of follow-up. Conclusions: Patients with poor immune status at switch to second-line ART were at greater risk of attrition and were less likely to suppress. Additional adherence support after switch may improve outcomes.

Original languageEnglish (US)
Pages (from-to)221-231
Number of pages11
JournalTropical Medicine and International Health
Volume22
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Keywords

  • HIV
  • antiretroviral therapy
  • death
  • loss to follow-up
  • second-line
  • virologic suppression

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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