Switching to second-line ART in relation to mortality in a large Tanzanian HIV cohort

4Citations
Citations of this article
68Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Objectives: In a large cohort of HIV-infected Tanzanians, we assessed: (i) rates of first-line treatment failure andswitches to second-line ART; (ii) the effect of switching to second-line ART on death and loss to follow-up; and(iii) treatment outcomes on second-line ART by regimen.Methods: HIV-1-infected adults (≥15 years) initiated on first-line ART between November 2004 and September2012, and who remained on initial therapy for at least 24 weeks before switching, were studied. Survival analyseswere conducted to examine the effect of second-line ART on mortality and loss to follow-up in: (i) the whole cohort;(ii) all patients eligible for second-line ART by immunological failure (IF) and/or virological failure (VF) criteria;and (iii) patients eligible by VF criteria.Results: In total, 47296 HIV-infected patients [mean age 37.5 (SD 9.5) years, CD4 175 (SD 158) cells/mm3, 71%female] were included in the analyses. Of these, 1760 (3.7%) patients switched to second-line ART (incidencerate"1.7/100 person-years). Higher rates of mortality were observed in switchers versus non-switchers in all patientsand patients with ART failure using IF/VF criteria. Switching only protected against mortality in patientswith ART failure defined virologically and with the highest level of adherence [switching versus non-switching;>95% adherence; adjusted HR"0.50 (95%CI"0.26-0.93); P"0.03].Conclusions: Switching patients to second-line ART may only be beneficial in a select group of patients who arevirologically monitored and demonstrate good adherence. Our data emphasize the need for routine viral loadmonitoring and aggressive adherence interventions in HIV programmes in sub-Saharan Africa.

References Powered by Scopus

Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men

1395Citations
N/AReaders
Get full text

Assessment of second-line antiretroviral regimens for HIV therapy in Africa

174Citations
N/AReaders
Get full text

Patterns of HIV-1 drug resistance after first-line antiretroviral therapy (ART) failure in 6 sub-saharan african countries: Implications for second-line ART strategies

148Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Second-line HIV treatment failure in subSaharan Africa: A systematic review and metaanalysis

41Citations
N/AReaders
Get full text

Detection of Drug Resistance Mutations in the Reverse Transcriptase Gene of HIV-1-Infected North Indian Population Failing First-Line Antiretroviral Therapy "A Follow-Up Cohort Study"

3Citations
N/AReaders
Get full text

Statistical analysis on the incidence and predictors of death among second-line ART patients in public hospitals of North Wollo and Waghemira Zones, Ethiopia, 2021

2Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Hawkins, C., Hertzmark, E., Spiegelman, D., Muya, A., Ulenga, N., Kim, S., … Fawzi, W. (2017). Switching to second-line ART in relation to mortality in a large Tanzanian HIV cohort. Journal of Antimicrobial Chemotherapy, 72(7), 2060–2068. https://doi.org/10.1093/jac/dkx098

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 25

68%

Researcher 6

16%

Lecturer / Post doc 4

11%

Professor / Associate Prof. 2

5%

Readers' Discipline

Tooltip

Medicine and Dentistry 17

52%

Nursing and Health Professions 7

21%

Pharmacology, Toxicology and Pharmaceut... 6

18%

Agricultural and Biological Sciences 3

9%

Save time finding and organizing research with Mendeley

Sign up for free