Virologic outcomes of second-line antiretroviral therapy in Eastern European country of Georgia

Abstract

BackgroundData on the effectiveness of second-line antiretroviral therapy (ART) in resource-limited countries of Eastern Europe is limited. Objective of this study was to evaluate virological outcomes of second-line ART in Georgia.MethodsWe conducted retrospective analysis using routinely available program data. Study included adult HIV-infected patients with confirmed HIV drug resistance, who were switched to second-line ART from August 2005 to December 2010. Patients were followed until July 1, 2011. Primary outcome was achievement of viral suppression. Demographic, clinical, laboratory and adherence data were abstracted from medical and program records. Adherence was expressed as percentage based on medication refill data, and was calculated as days supply of medications dispensed divided by days between prescription fills. Predictors of primary outcome were assessed in modified Poisson regression analysis.ResultsA total of 84 patients were included in the study. Among them 71.4% were men and 62% had history of IDU. All patients were receiving non-nucleoside reverse transcriptase based regimen as initial ART. The mean 6-month adherence prior to virologic failure was 75%, with 31% of patients showing 100% adherence. All patients were switched to protease inhibitor based regimens. Patients were followed for median 27 months. Over this period 9 (10.7%) patients died. Among 80 patients remaining alive at least 6 month after ART regimen switch, 72 (90%) patients ever reached undetectable viral load. The mean first 6-month adherence on second-line treatment was 81%, with 47.5% of patients showing 100% adherence. The proportion of patients achieving viral suppression after 6, 12, 24 and 36 months of second-line ART did not vary significantly ranging from 79 to 83%. Percentage of IDUs achieving viral suppression ranged from 75% and 83%. Factors associated with failure to achieve viral suppression at 6-months of second-line ART were: adherence <80% (Risk ratio [RR] 5.09, 95% CI: 1.89-13.70) and viral load >100,000 at the time of treatment failure (RR 3.39, 95% CI: 1.46-7.89).ConclusionsThe study demonstrated favourable virological outcomes of the second-line ART in Georgia. Majority of patients, including IDUs, achieved sustained virological response over 36 month period. The findings highlight the need of improving adherence.

Facteurs associés à la non observance thérapeutique des sujets adultes infectés par le VIH sous antirétroviraux dans un hôpital de référence à Douala

“…Cette étude s'est fixée pour objectifs de déterminer la prévalence de la NO des PVVIH sous antirétroviraux, de déterminer les caractéristiques socio-démographiques et les facteurs de la NO. Ces objectifs sont proches de ceux de Chkhartishvil et al qui s’étaient penchés sur l’évaluation de l'adhérence aux TAR dans les pays de l'Europe de l'Est [ 20 ].…”

Can Short-Term Use of Electronic Patient Adherence Monitoring Devices Improve Adherence in Patients Failing Second-Line Antiretroviral Therapy? Evidence from a Pilot Study in Johannesburg, South Africa

“…The total number of days from enrolment was determined as follows: until study staff deactivated the device (definition 1), until the last event recorded (definition 2), or until the repeat viral load date (definition 3). We considered two cut-offs to define good adherence; either taking at least 80 % (missing ≥20 %) or taking at least 95 % (missing ≥5 %) of the prescribed medication [ 7 ].…”

“…Continuous variables are described using medians with corresponding interquartile ranges (IQR) and categorical variables are expressed as simple proportions. For the intervention cohort log-binomial regression was used to estimate the association between poor adherence (defined as either ≤ 95 % or ≤ 80 % [ 7 ] of required scheduled dose) and unsuppressed virus (≥400 copies/ml) between 3 and 6 months after enrolment.…”

“…Despite the huge successes in increasing HIV treatment coverage, most patients who experience virologic failure on second-line ART in low-middle income countries fail due to poor adherence rather than resistance to a class of ART drugs [ 4 , 5 ]. For patients on second-line protease inhibitor-based ART, high levels (≥80 %) of adherence are required for viral suppression and poorer outcomes are observed when adherence drops [ 6 , 7 ].…”

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

“…The WHO treatment guidelines recommended combination antiretroviral therapy (cART) initiation to all HIV infected adolescents to prevent HIV-related morbidity and mortality [7]. Some evidence has shown that access to cART to treat HIV infection and AIDS in resource-poor countries had improved over the past several years [8]. The cART when taken correctly could lead to sustained viral suppression and reduction in occurrence of AIDS-defining and non-AIDS-defining complications.…”