High efficacy of lopinavir/r‐based second‐line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia

Abstract

BackgroundThe number of patients on second-line highly active antiretroviral therapy (HAART) regimens is increasing in resource-limited settings. We describe the outcomes after 24 months for patients on LPV/r-based second-line regimens followed up by the ESTHER programme in Phnom Penh, Cambodia.MethodsSeventy patients who initiated second-line HAART regimens more than 24 months earlier were included, and immuno-virological data analyzed. HIV RNA viral load was determined by real-time RT-PCR. HIV-1 drug resistance was interpreted according to the ANRS algorithm.ResultsOf the 70 patients, two were lost to follow up, three died and 65 (92.8%) remained on second-line treatment after 24 months of follow up (median duration of treatment: 27.4 months). At switch to second-line, the median CD4 T cell count was 106 cells/mm3 and the median viral load was 4.7 Log10. Second-line regimens prescribed were ddI/3TC/LPV/r (65.7%), ddI/TDF/LPV/r (10.0%), ddI/AZT/LPV/r (8.6%) and TDF/3TC/LPV/r (7.1%). The median CD4 T cell gain was +258 cells/mm3 at 24 months (n = 63). After 24 months of follow up, 92.3% (60/65) of the patients presented undetectable viral loads, giving an overall treatment success rate of 85.7% (CI: 75.6- 92.0) in intent-to-treat analysis.ConclusionsThese data suggest that a LPV/r-based second-line regimen is associated with a high rate of virological suppression and immune reconstitution after 24 months of follow up in Cambodia.

A Prospective Study to Evaluate Prescription Pattern of Second Line Antiretroviral Therapy Given to HIV Patients

“…[19] [n=328] Ferradini L et al, 2011 [20] [n = 70] 26 which was comparable to 67% in Rotger M et al study 27 and 44% in Castle study. 28 High-level adherence to antiretroviral therapy is associated with favorable patient outcomes.…”

Efficacy of Second-Line Antiretroviral Therapy Among People Living With HIV/AIDS in Asia

“…Ferradini et al (2011) found 85.7% of 70 HIV-infected study participants at a center in Phnom Penh had undetectable viral load after 24 weeks of second-line ART containing LPV/r. 6 Recent evidence from southern Africa also suggests that regimens without tenofovir may impair the durability of second-line ART. 28 Baseline CD4 cell count was not associated with failure in our final model, however, another important measure of HIV disease status, baseline viral load, was.…”

“…In a study of second-line regimens containing LPV/r at a center in Cambodia, 85.7% of the 70 HIV-infected study participants had an undetectable viral load at 24 weeks. 6 However, significant challenges remain. A 2010 Cochrane review concluded that while outcomes of second-line regimens with boosted PIs are generally favorable, there is limited evidence to evaluate second-line ART in patients who fail first-line WHO-recommended treatment.…”

“…7 Furthermore, very little of the currently available literature describes second-line ART outcomes in HIV-infected patients in Asia. 6, 8-10 …”

EVOLUTION OF PATIENTS WITH AIDS AFTER cART: CLINICAL AND LABORATORY EVOLUTION OF PATIENTS WITH AIDS AFTER 48 WEEKS OF ANTIRETROVIRAL TREATMENT

“…After 12 weeks of treatment, G1 and G2 presented an equal mean increase of 141 cells and 144 cells. FERRADINI et al 8 in Cambodia, Asia, showed that a strong immune reconstitution was observed after 24 months (gain of 258 cells/mm 3 [IQR: 136-425]) of follow-up on second-line cART regimens. In 2010 in Brazil, a study by SANTOS et al 33 that compared these cell counts before and after 36 months of treatment regardless of the ARV scheme used, demonstrated an average increase of 225 T CD4+ cells.…”