Abstract
OBJECTIVE: To determine initial 24-week outcomes among prospectively enrolled patients with failure of initial antiretroviral therapy (ART). METHODS: Baseline virologic failure was defined as HIV-1 viral load greater than 1000 copies/ml. Second-line ART was informed by results of genotype testing and selected from agents in the South-African public sector. Twenty-four week endpoints included virologic suppression and mortality. RESULTS: The cohort consisted of 141 patients (median CD4 cell count and viral load at failure of 173 cells/μl and 17 500 copies/ml). The median prior duration of initial ART was 12.0 months. At least one major resistance mutation was found in 87% of patients.After 24 weeks of follow-up, intent-to-treat virologic suppression (<50 copies/ml) was 65%, as-treated virologic suppression was 78%, the median CD4 cell count improvement was 88 cells/μl and the mortality was 6%. The median CD4 cell count at initial virologic failure among those who died was 70 cells/μl, compared to 182 cells/μl among patients who survived (P = 0.01). Patients with wild-type virus at initial failure (N = 19) had inferior outcomes after switch. The presence of nucleoside analogue resistance mutations at failure did not affect early efficacy of boosted-protease inhibitor regimens. CONCLUSIONS: Virologic monitoring linked to resistance testing helped demonstrate the efficacy of lopinavir/ritonavir-containing second-line regimens in South Africa. A switch to second-line regimens in patients with virologic failure and drug resistance has substantial and rapid immunological and clinical benefits. Resistance testing identified a high-risk group without resistance who might benefit from increased medication access and/or adherence support.
Original language | English (US) |
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Pages (from-to) | 1007-1012 |
Number of pages | 6 |
Journal | AIDS |
Volume | 24 |
Issue number | 7 |
DOIs | |
State | Published - Apr 2010 |
Externally published | Yes |
Keywords
- HIV-1 drug resistance
- Resource-limited settings
- Second-line antiretroviral therapy
- South Africa
- Virologic failure
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases