Effectiveness of second-line antiretroviral therapy: the impact of drug switches

• Autor(a) principal: Letícia Penna Braga
• Data de Publicação: 2017
• Outros Autores: Cássia Cristina Pinto Mendicino, Edna Afonso Reis, Ricardo Andrade Carmo, Cristiane Aparecida Menezes de Pádua
• Tipo de documento: Artigo de conferência
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.1002/pds.4275; http://hdl.handle.net/1843/46469
• topic: HIV; AIDS; Terapia antirretroviral; Estudos de coorte; HIV; AIDS

Background: Including antiretroviral drug switches as a measure of ART failure could be more suitable than conventional measures to evaluate health outcomes in ‘real-world’ settings. Objectives: Evaluate the effectiveness of second-line ART in HIV-infected adults participating in a historical cohort study, comparing two scenarios by using different parameters to characterize ART failure. Methods: This is part of a historical cohort of HIV-infected adults who initiated ART from 2001 to 2005, and were followed up for a maximum of five years, conducted in three HIV/AIDS centers in Belo Horizonte, Brazil. Follow-up information included data from 2001 to 2010. All patients switched from first-line to second-line ART were included. Secondline ART effectiveness was measured as the timeto-ART failure. Failure was defined simulating to scenarios: (1) Clinical, immunological and virological failure (scenario 1); or scenario 1 plus ART switches (scenario 2). Descriptive analysis, Kaplan-Meier curves, log-rank test, and Cox proportional hazards model were performed. Results: A total of 119 patients were eligible; most had protease inhibitor (PI)-based regimens prescribed as second-line. The incidence of failure was different for the two scenarios (29.4% vs. 54.6% for scenario 1 and 2, respectively; p= 0.00). The main identifiers of failure were increase in viral load (31.1%) for scenario 1 and ART switches (42.8%) for scenario 2. Median duration on second-line ART was 36.8 vs. 19.8 months for scenario 1 and 2, respectively. In the Cox analysis of scenario 2, increased risk was found for patients given PI-based second-line regimens (HR = 2.26; 95% CI: 1.09–3.17). Conclusions: There is a high incidence of ART failure associated with PI-based regimens when ART switches are considered as an indicator of failure. This demonstrates the impact of ART switches in representing lack of ART effectiveness.