Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Abstract

Background: Myanmar has a high burden of Human Immunodeficiency Virus (HIV) and second-line antiretroviral treatment (ART) has been available since 2008 in the public health sector. However, there have been no published data about the outcomes of such patients until now.Objective: To assess the treatment and programmatic outcomes and factors associated with unfavorable outcomes (treatment failure, death and loss to follow-up from care) among people living with HIV (aged ≥ 10 years) receiving protease inhibitor-based second-line ART under the Integrated HIV Care Program in Myanmar between October 2008 and June 2015.Design: Retrospective cohort study using routinely collected program data.Results: Of 824 adults and adolescents on second-line ART, 52 patients received viral load testing and 19 patients were diagnosed with virological failure. However, their treatment was not modified. At the end of a total follow-up duration of 7 years, 88 (11%) patients died, 35 (4%) were lost to follow-up, 21 (2%) were transferred out to other health facilities and 680 (83%) were still under care. The incidence rate of unfavorable outcomes was 7.9 patients per 100 person years follow-up. Patients with a history of injecting drug use, with a history of lost to follow-up, with a higher baseline viral load and who had received didanosine and abacavir had a higher risk of unfavorable outcomes. Patients with higher baseline C4 counts, those having taken first-line ART at a private clinic, receiving ART at decentralized sites and taking zidovudine and lamivudine had a lower risk of unfavorable outcomes.Conclusions: Long-term outcomes of patients on second-line ART were relatively good in this cohort. Virological failure was relatively low, possibly because of lack of viral load testing. No patient who failed on second-line ART was switched to third-line treatment. The National HIV/AIDS Program should consider making routine viral load monitoring and third-line ART drugs available after a careful cost–benefit analysis.

Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study

“…The overall incidence of second-line treatment failure in this study was similar with studies conducted in African and Asian countries [ 18 – 20 ]. However, the incidence of the treatment failure of this study was lower as compared to the study conducted in South Africa, other studies from African and Asian patients, Amhara region, Ethiopia (9.86 per 100 PYs) and systematic analysis (15.0 per 100 PYs) [ 17 , 21 – 23 ].…”

Magnitude and correlates of virological failure among adult HIV patients receiving PI based second line ART regimens in north western Tanzania; a case control study

“…Another comparatively higher rate of virological failure of 17.7% was reported in India among patients who were on second line ART beyond 1 year [12] and in South Africa where it was shown that about 23% of patients who failed on first line ART experienced virological failure after 1 year of treatment with second line ART [11]. A much higher rate of virological failure of 37% was also recently reported from Myanmar Asia among patient who were on second line ART [22].…”

Determinants of first line antiretroviral therapy treatment failure among adult patients on ART at central Ethiopia: un-matched case control study

“…First-line led to longer life expectancy (28.8 years) and lower life time costs ($41,350/person, from lower second-line costs) [14]. Some studies also showed that the occurrence of un- favorable outcome as death, lost to follow up and virologic failure occurs at rate of 7.9 patients per 100 person years follow-up in patients on second line ART regimens [15]. Many research also revealed that early mortality, drug toxicity and resistance is high in second line ART [16].…”