Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières
dc.contributor.author | Pujades-Rodriguez, M | |
dc.contributor.author | O'Brien, D | |
dc.contributor.author | Humblet, P | |
dc.contributor.author | Calmy, A | |
dc.date.accessioned | 2008-07-25T09:33:56Z | |
dc.date.available | 2008-07-25T09:33:56Z | |
dc.date.issued | 2008-07-11 | |
dc.date.submitted | 2008-07-14 | |
dc.identifier.citation | AIDS 2008;22(11):1305-12 | en |
dc.identifier.issn | 1473-5571 | |
dc.identifier.pmid | 18580610 | |
dc.identifier.doi | 10.1097/QAD.0b013e3282fa75b9 | |
dc.identifier.uri | http://hdl.handle.net/10144/33194 | |
dc.description.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. | |
dc.language.iso | en | en |
dc.rights | Published by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluwer | en |
dc.subject | Second-line treatment | en |
dc.subject.mesh | Anti-HIV Agents | en |
dc.subject.mesh | Antiretroviral Therapy, Highly Active | en |
dc.subject.mesh | Developing Countries | en |
dc.subject.mesh | Drug Therapy, Combination | en |
dc.subject.mesh | HIV Infections | en |
dc.subject.mesh | Reverse Transcriptase Inhibitors | en |
dc.subject.mesh | Treatment Failure | en |
dc.subject.mesh | Treatment Outcome | en |
dc.subject.mesh | Viral Load | en |
dc.title | Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières | en |
dc.type | Article | en |
dc.contributor.department | Epicentre, Paris, France; Médecins Sans Frontières, Paris, France; Campaign for Access to Essential Medicines, Geneva, Switzerland | en |
dc.identifier.journal | AIDS (London, England) | en |
refterms.dateFOA | 2019-03-04T11:28:47Z | |
html.description.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. |