Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières

Hdl Handle:
http://hdl.handle.net/10144/33194
Title:
Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières
Authors:
Pujades-Rodriguez, M; O'Brien, D; Humblet, P; Calmy, A
Journal:
AIDS (London, England)
Abstract:
OBJECTIVES: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival. DESIGN/METHODS: We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression. RESULTS: Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl. CONCLUSION: The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment.
Affiliation:
Epicentre, Paris, France; Médecins Sans Frontières, Paris, France; Campaign for Access to Essential Medicines, Geneva, Switzerland
Issue Date:
11-Jul-2008
URI:
http://hdl.handle.net/10144/33194
DOI:
10.1097/QAD.0b013e3282fa75b9
PubMed ID:
18580610
Submitted date:
2008-07-14
Type:
Article
Language:
en
ISSN:
1473-5571
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorPujades-Rodriguez, M-
dc.contributor.authorO'Brien, D-
dc.contributor.authorHumblet, P-
dc.contributor.authorCalmy, A-
dc.date.accessioned2008-07-25T09:33:56Z-
dc.date.available2008-07-25T09:33:56Z-
dc.date.issued2008-07-11-
dc.date.submitted2008-07-14-
dc.identifier.citationAIDS 2008;22(11):1305-12en
dc.identifier.issn1473-5571-
dc.identifier.pmid18580610-
dc.identifier.doi10.1097/QAD.0b013e3282fa75b9-
dc.identifier.urihttp://hdl.handle.net/10144/33194-
dc.description.abstractOBJECTIVES: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival. DESIGN/METHODS: We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression. RESULTS: Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl. CONCLUSION: The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subjectSecond-line treatmenten
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshHIV Infectionsen
dc.subject.meshReverse Transcriptase Inhibitorsen
dc.subject.meshTreatment Failureen
dc.subject.meshTreatment Outcomeen
dc.subject.meshViral Loaden
dc.titleSecond-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontièresen
dc.typeArticleen
dc.contributor.departmentEpicentre, Paris, France; Médecins Sans Frontières, Paris, France; Campaign for Access to Essential Medicines, Geneva, Switzerlanden
dc.identifier.journalAIDS (London, England)en

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