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PLoS One. 2014 Sep 15;9(9):e106887. doi: 10.1371/journal.pone.0106887. eCollection 2014.

Use of third line antiretroviral therapy in Latin America.

Author information

1
Fundación Huésped, Buenos Aires, Argentina.
2
Vanderbilt University, Nashville, Tennessee, United States of America.
3
Pan American Health Organization, Washington, D.C., United States of America.
4
Instituto de Pesquisa Clinica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
5
Universidad de Chile, Santiago, Chile.
6
Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras.
7
Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
8
Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.
9
Coordinación Sida, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.

Abstract

BACKGROUND:

Access to highly active antiretroviral therapy (HAART) is expanding in Latin America. Many patients require second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART, essential for program planning, is not known.

METHODS:

Antiretroviral-naïve patients ≥18 years who started first HAART after January 1, 2000 in Caribbean, Central and South America Network (CCASAnet) sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART.

RESULTS:

Of 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3%) failed a second line regimen and 44 (0.8%) received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18-2.00, p = 0.001), younger age (HR = 2.76 for 20 vs. 40 years, 95% CI 1.86-4.10, p<0.001), and prior AIDS (HR = 2.17, 95% CI 1.62-2.90, p<0.001).

CONCLUSIONS:

Third line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third line regimens is warranted.

PMID:
25221931
PMCID:
PMC4164470
DOI:
10.1371/journal.pone.0106887
[Indexed for MEDLINE]
Free PMC Article

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