Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation

Desmonde, Sophie; Eboua, François Tanoh; Malateste, Karen; Dicko, Fatoumata; Ekouévi, Didier K.; N’Gbeche, Sylvie; Kouéta, Fla; Sy, Haby Signaté; Renner, Lorna; Koumakpai, Siriatou A.; Leroy, Valériane

doi:10.1097/qad.0000000000000707

Cited by 20 publications

(26 citation statements)

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“…Because the tuberculosis data were incompletely reported, we could not completely explore this hypothesis. The finding that older age at initiation of ART is associated with an increased likelihood of switching has been previously reported 11,13 and could be partly due to the lack of available paediatric formulations for young children and poorer adherence among adolescents than among younger children. The increased incidence of switching among male patients has been previously reported in paediatric and adult cohorts, 11,12,29 and warrents further study.…”

Section: Discussionsupporting

confidence: 53%

Incidence of switching to second-line antiretroviral therapy and associated factors in children with HIV: an international cohort collaboration

Collins¹,

Wools‐Kaloustian²,

Goodall³

et al. 2019

The Lancet HIV

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Background Estimates of incidence of switching to second-line antiretroviral therapy (ART) among children with HIV are necessary to inform the need for paediatric second-line formulations. We aimed to quantify the cumulative incidence of switching to second-line ART among children in an international cohort collaboration. Methods In this international cohort collaboration study, we pooled individual patient-level data for children younger than 18 years who initiated ART (two or more nucleoside reverse-transcriptase inhibitors [NRTI] plus a non-NRTI [NNRTI] or boosted protease inhibitor) between 1993 and 2015 from 12 observational cohort networks in the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Global Cohort Collaboration. Patients who were reported to be horizontally infected with HIV and those who were enrolled in trials of treatment monitoring, switching, or interruption strategies were excluded. Switch to second-line ART was defined as change of one or more NRTI plus either change in drug class (NNRTI to protease inhibitor or vice versa) or protease inhibitor change, change from single to dual protease inhibitor, or addition of a new drug class. We used cumulative incidence curves to assess time to switching, and multivariable proportional hazards models to explore patient-level and cohort-level factors associated with switching, with death and loss to follow-up as competing risks. Findings At the data cutoff of Sept 16, 2015, 182 747 children with HIV were included in the CIPHER dataset, of whom 93 351 were eligible, with 83 984 (90•0%) from sub-Saharan Africa. At ART initiation, the median patient age was 3•9 years (IQR 1•6-6•9) and 82 885 (88•8%) patients initiated NNRTI-based and 10 466 (11•2%) initiated protease inhibitor-based regimens. Median duration of follow-up after ART initiation was 26 months (IQR 9-52). 3883 (4•2%) patients switched to second-line ART after a median of 35 months (IQR 20-57) of ART. The cumulative incidence of switching at 3 years was 3•1% (95% CI 3•0-3•2), but this estimate varied widely depending on the cohort monitoring strategy, from 6•8% (6•5-7•2) in settings with routine monitoring of CD4 (CD4% or CD4 count) and viral load to 0•8% (0•6-1•0) in settings with clinical only monitoring. In multivariable analyses, patient-level factors associated with an increased likelihood of switching were male sex, older age at ART initiation, and initial NNRTI-based regimen (p<0•0001). Cohort-level factors that increased the likelihood of switching were higher-income country (p=0•0017) and routine or targeted monitoring of CD4 and viral load (p<0•0001), which was associated with a 166% increase in likelihood of switching compared with CD4 only monitoring (subdistributional hazard ratio 2•66, 95% CI 2•22-3•19). Interpretation Our global paediatric analysis found wide variations in the incidence of switching to second-line ART across monitoring strategies. These findings suggest the scale-up of viral load monitoring would probably increase demand for paediatri...

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Section: Discussionsupporting

confidence: 53%

Incidence of switching to second-line antiretroviral therapy and associated factors in children with HIV: an international cohort collaboration

Collins¹,

Wools‐Kaloustian²,

Goodall³

et al. 2019

The Lancet HIV

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“…Twenty-two (62.9%) of the deaths occurred during the first year of follow-up. The total number of deaths that occurred in this study is much lower than was reported in a study conducted in Debre-Markos Hospital, Ethiopia, where 40.7% of patients died [ 18 ]. Moreover, data from Senegal, Malawi, and Tanzania have indicated high rates of HIV-related mortality, ranging from 24.2 to 44.0% [ 30 ], in contrast to the present study.…”

Section: Discussionmentioning

confidence: 57%

Survival and predictors of mortality among HIV patients on anti-retroviral treatment at Jinka hospital, South Omo, Ethiopia

Tachbele

Ameni

2016

Epidemiol Health

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OBJECTIVESThe survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia.METHODSA 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models.RESULTSOf the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97).CONCLUSIONSPatients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

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“…This rate is lower than the rate of switching that has been reported from Uganda at 24 months (65.0%) following a VF [ 21 ]. A study has also reported an association between poor adherence and switch to second-line regimen [ 26 ]. In addition to the behaviour of patients while receiving a specific regimen, the ability of care providers to take a clinical decision to switch also depends on the availability of second-line and even third-line ARV regimens.…”

Section: Discussionmentioning

confidence: 99%

Viral load testing and the use of test results for clinical decision making for HIV treatment in Cameroon: An insight into the clinic-laboratory interface

et al. 2018

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BackgroundThe viral load (VL) in patients receiving antiretroviral therapy (ART) is the best predictor of treatment outcome. The anticipated benefits of VL monitoring depend on the actual uptake of VL test results for clinical decisions. The objective of this study was to assess the uptake and utilization of VL test results for clinical decisions on HIV treatment in Cameroon, from 2013 to 2017.MethodsThis was a retrospective cohort analysis of data from files of patients receiving ART at Buea, Limbe, Bamenda and Bafoussam regional hospital HIV treatment centers. A simple random pick of six file blocks was performed in each shelf that corresponded to a year of initiation, and the contents of all selected files were reviewed and the information needed for the study entered a structured questionnaire. The data collected was recorded in Epi Info (version 7.1.5.2), and analyzed using SATA (version 12.1; StataCorp LP).ResultsEight hundred and thirty files were reviewed. The mean duration on ART was 39.4±12 months. Viral load testing uptake was 24.33% and only one VL test had been done by all patients. Approximately 65% of the patients did the first VL after more than 24 months on ART. The median turnaround (TAT) time for VL testing was 6 days (Interquartile range (IQR) 3-7days). Among 201 patients who did a VL test, 94.55% had VL suppression (≤1000copies/mm3). Approximately 54% of the patients with virologic failure were switched to a second-line regimen.ConclusionsThe uptake of viral load testing is low in North West, South West and West Regions of Cameroon. The current TAT for VL testing is plausible. The rate of switch to second line regimen is low. It is time to strengthen the scale up of VL testing and improve the rate of switch to second-line regimen in Cameroon.

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Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation

Cited by 20 publications

References 16 publications

Incidence of switching to second-line antiretroviral therapy and associated factors in children with HIV: an international cohort collaboration

Incidence of switching to second-line antiretroviral therapy and associated factors in children with HIV: an international cohort collaboration

Survival and predictors of mortality among HIV patients on anti-retroviral treatment at Jinka hospital, South Omo, Ethiopia

Viral load testing and the use of test results for clinical decision making for HIV treatment in Cameroon: An insight into the clinic-laboratory interface

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