Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India
Van den Bergh, R
Wut Yee Kyaw, K
Arago Galindo, M
MetadataShow full item record
AbstractBACKGROUND: HIV 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. OBJECTIVE: To document the outcome and genotype of presumptive second-line ART failure cases switched to third-line or maintained on second-line ART. DESIGN: Retrospective cohort study of patients referred between January 2011 and September 2017. RESULTS: The 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. CONCLUSION: Adopting 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.
- Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India.
- Authors: Khan S, Das M, Andries A, Deshpande A, Mansoor H, Saranchuk P, Isaakidis P
- Issue date: 2014
- Drug resistance testing through remote genotyping and predicted treatment options in human immunodeficiency virus type 1 infected Tanzanian subjects failing first or second line antiretroviral therapy.
- Authors: Svärd J, Mugusi S, Mloka D, Neogi U, Meini G, Mugusi F, Incardona F, Zazzi M, Sönnerborg A
- Issue date: 2017
- HIV multi-drug resistance at first-line antiretroviral failure and subsequent virological response in Asia.
- Authors: Jiamsakul A, Sungkanuparph S, Law M, Kantor R, Praparattanapan J, Li PC, Phanuphak P, Merati T, Ratanasuwan W, Lee CK, Ditangco R, Mustafa M, Singtoroj T, Kiertiburanakul S, TREAT Asia Studies to Evaluate Resistance – Monitoring Study (TASER-M).
- Issue date: 2014
- Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland.
- Authors: Etoori D, Ciglenecki I, Ndlangamandla M, Edwards CG, Jobanputra K, Pasipamire M, Maphalala G, Yang C, Zabsonre I, Kabore SM, Goiri J, Teck R, Kerschberger B
- Issue date: 2018 Oct
- One-, two-, and three-class resistance among HIV-infected patients on antiretroviral therapy in private care clinics: Mumbai, India.
- Authors: Gupta A, Saple DG, Nadkarni G, Shah B, Vaidya S, Hingankar N, Chaturbhuj D, Deshmukh P, Walshe L, Hudelson SE, James M, Paranjape RS, Eshleman SH, Tripathy S
- Issue date: 2010 Jan