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J Acquir Immune Defic Syndr. 2018 Apr 1;77(4):413-416. doi: 10.1097/QAI.0000000000001611.

Brief Report: Assessing the Association Between Changing NRTIs When Initiating Second-Line ART and Treatment Outcomes.

Author information

1
Center for Global Health and Development, Boston University, Boston, MA.
2
Division of Infectious Diseases, Department of Internal Medicine, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
3
Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA.
4
Department of Epidemiology, Boston University School of Public Health, Boston, MA.
5
Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC.
6
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
7
The Aurum Institute, Johannesburg, South Africa.
8
Department of Medicine, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
9
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
10
McCord Hospital, Durban, South Africa.
11
Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.
12
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
13
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
14
School of Medicine, University of Zambia, Lusaka, Zambia.
15
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
16
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
17
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

BACKGROUND:

After first-line antiretroviral therapy failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line.

SETTING:

We used clinical data from 6290 adult patients in South Africa and Zambia from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa cohort.

METHODS:

We included patients who initiated on standard first-line antiretroviral therapy and had evidence of first-line failure. We used propensity score-adjusted Cox proportional-hazards models to evaluate the impact of change in NRTI on second-line failure compared with remaining on the same NRTI in second line. In South Africa, where viral load monitoring was available, treatment failure was defined as 2 consecutive viral loads >1000 copies/mL. In Zambia, it was defined as 2 consecutive CD4 counts <100 cells/mm.

RESULTS:

Among patients in South Africa initiated on zidovudine (AZT), the adjusted hazard ratio for second-line virologic failure was 0.25 (95% confidence interval: 0.11 to 0.57) for those switching to tenofovir (TDF) vs. remaining on AZT. Among patients in South Africa initiated on TDF, switching to AZT in second line was associated with reduced second-line failure (adjusted hazard ratio = 0.35 [95% confidence interval: 0.13 to 0.96]). In Zambia, where viral load monitoring was not available, results were less conclusive.

CONCLUSIONS:

Changing NRTI in second line was associated with better clinical outcomes in South Africa. Additional clinical trial research regarding second-line NRTI choices for patients initiated on TDF or with contraindications to specific NRTIs is needed.

PMID:
29206723
PMCID:
PMC5825249
DOI:
10.1097/QAI.0000000000001611
[Indexed for MEDLINE]
Free PMC Article

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