Long-term outcomes of over one thousand patients on second-line antiretroviral therapy in South Africa

Abstract

Design: We conducted a retrospective cohort study of HIV-infected adults (≥18) who initiated standard first-line antiretroviral therapy (ART), failed first-line ART, and then switched to second-line treatment at one of four public-sector facilities in Johannesburg, South Africa from April 2004 to September 2012. Analysis: We used Kaplan-Meier analysis to estimate attrition (death or loss to follow-up [LTF]) over eight years; One-year incidence rates of attrition are presented per 1000 person-years; Cox proportional hazards regression was used to examine predictors of one-year attrition and results are presented as hazard ratios (HR) with corresponding 95% confidence intervals (CI).Results: 1304 patients included; Median (IQR) CD4 count at 2nd-line initiation 226 (137-335) cells/mm3, Patients followed a median (IQR) of 23.1 (14.2-36.9) months on 2nd-line ART; At the end of follow-up, 7.4% of patients had died and 19.5% were LTF; Over time, rates of attrition over one-year on second-line were stable between 102.5/1000 and 109.6/1000 person-years; Patients who initiated second-line with a viral load ≥50,000 copies/mL were >2x as likely to die or become lost after 2nd-line initiation vs. patients with a viral load <5,000 copies/mL. Conclusions: We found little increased risk of poor treatment outcomes as scale-up for 2nd-line increased; We saw poorer outcomes associated with higher viral load at switch so interventions for earlier switch should be considered.

Conference: IWHOD 2014, Sitges, Spain