Second-line antiretroviral therapy: Long-term outcomes in South Africa

Richard A. Murphy, Henry Sunpath, Carmen Castilla, Shameez Ebrahim, Richard Court, Hoang Nguyen, Daniel R. Kuritzkes, Vincent C. Marconi, Jean B. Nachega

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

BACKGROUND: Currently, boosted protease inhibitor-containing regimens are the only option after first-line regimen failure available for patients in most resource-limited settings, yet little is known about long-term adherence and outcomes. METHODS: We enrolled patients with virologic failure (VF) who initiated lopinavir/ritonavir-containing second-line antiretroviral therapy (ART). Medication possession ratios were calculated using pharmacy refill dates. Factors associated with 12-month second-line virologic suppression [viral load (VL) <50 copies/mL] and adherence were determined. RESULTS: One hundred six patients (median CD4 count and VL at failure: 153 cells/mm and 28,548 copies/mL, respectively) were enrolled. Adherence improved after second-line ART switch (median adherence 6 months prior, 67%; median adherence during initial 6 months of second-line ART, 100%; P = 0.001). Higher levels of adherence during second-line ART was associated with virologic suppression at month 12 of ART (odds ratio 2.5 per 10% adherence increase, 95% CI 1.3 to 4.8, P = 0.01). Time to virologic suppression was most rapid among patients with 91%-100% adherence compared with patients with 80%-90% and <80% adherence (log rank test, P = 0.01). VF during 24 months of second-line ART was moderate (month 12: 25%, n = 32/126; month 18: 21%, n = 23/112; and month 24: 25%, n = 25/99). CONCLUSIONS: The switch to second-line ART in South Africa was associated with an improvement in adherence, however, a moderate ongoing rate of VF-among approximately 25% of patients receiving second-line ART patients at each follow-up interval-was a cause for concern. Adherence level was associated with second-line ART virologic outcome, helping explain why some patients achieved virologic suppression after switch and others did not.

Original languageEnglish (US)
Pages (from-to)158-163
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume61
Issue number2
DOIs
StatePublished - Oct 1 2012

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South Africa
Therapeutics
Viral Load
Lopinavir
Ritonavir
CD4 Lymphocyte Count
Protease Inhibitors
Odds Ratio

Keywords

  • adherence
  • resourcelimited settings
  • second-line antiretroviral therapy
  • South Africa

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Murphy, R. A., Sunpath, H., Castilla, C., Ebrahim, S., Court, R., Nguyen, H., ... Nachega, J. B. (2012). Second-line antiretroviral therapy: Long-term outcomes in South Africa. Journal of Acquired Immune Deficiency Syndromes, 61(2), 158-163. https://doi.org/10.1097/QAI.0b013e3182615ad1

Second-line antiretroviral therapy : Long-term outcomes in South Africa. / Murphy, Richard A.; Sunpath, Henry; Castilla, Carmen; Ebrahim, Shameez; Court, Richard; Nguyen, Hoang; Kuritzkes, Daniel R.; Marconi, Vincent C.; Nachega, Jean B.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 61, No. 2, 01.10.2012, p. 158-163.

Research output: Contribution to journalArticle

Murphy, RA, Sunpath, H, Castilla, C, Ebrahim, S, Court, R, Nguyen, H, Kuritzkes, DR, Marconi, VC & Nachega, JB 2012, 'Second-line antiretroviral therapy: Long-term outcomes in South Africa', Journal of Acquired Immune Deficiency Syndromes, vol. 61, no. 2, pp. 158-163. https://doi.org/10.1097/QAI.0b013e3182615ad1
Murphy, Richard A. ; Sunpath, Henry ; Castilla, Carmen ; Ebrahim, Shameez ; Court, Richard ; Nguyen, Hoang ; Kuritzkes, Daniel R. ; Marconi, Vincent C. ; Nachega, Jean B. / Second-line antiretroviral therapy : Long-term outcomes in South Africa. In: Journal of Acquired Immune Deficiency Syndromes. 2012 ; Vol. 61, No. 2. pp. 158-163.
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