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- Title
Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria.
- Authors
Onyedum, Cajetan C.; Iroezindu, Michael O.; Chukwuka, Chinwe J.; Anyaene, Chukwujekwu E.; Obi, Frank I.; Young, Ekenechukwu E.
- Abstract
Background Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART. Methods In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months. Results Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1–6.3) log10 copies/ml and 71 (6–610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002). Conclusion The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings.
- Subjects
HIV-positive persons; ANTIRETROVIRAL agents; HEALTH outcome assessment; HIV infections; THERAPEUTICS; RETROSPECTIVE studies; REVERSE transcriptase inhibitors; THERAPEUTIC use of protease inhibitors
- Publication
Transactions of the Royal Society of Tropical Medicine & Hygiene, 2013, Vol 107, Issue 10, p608
- ISSN
0035-9203
- Publication type
Article
- DOI
10.1093/trstmh/trt071