Universität zu Köln

Sarfo, Fred S., Castelnuovo, Barbara ORCID: 0000-0001-7756-5032, Fanti, Iuri, Feldt, Torsten, Incardona, Francesca, Kaiser, Rolf, Lwanga, Isaac, Marrone, Gaetano, Sonnerborg, Anders ORCID: 0000-0001-8928-3374, Tufa, Tafese B., Zazzi, Maurizio ORCID: 0000-0002-0344-6281 and De Luca, Andrea ORCID: 0000-0002-9561-9193 (2019). Longer-term effectiveness of protease-inhibitor-based second line antiretroviral therapy in four large sub-Saharan African clinics. J. Infect., 78 (5). S. 402 - 409. LONDON: W B SAUNDERS CO LTD. ISSN 1532-2742

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Abstract

Objectives: Data on the longer-term effectiveness of second line combination antiretroviral therapy (ART) in sub-Saharan Africa (SSA) are lacking. We sought to assess the probability and determinants of 2nd line ART failure in SSA. Methods: A retrospective, multi-center study of 2nd line ART initiated between 2005 and 2017 at four ART centers in Ethiopia, Ghana and Uganda. Main outcome measure was virologic failure (VF) defined as VL>1000 copies/ml after >6 months on 2nd line therapy. Predictors of VF and virologic re-suppression on 2nd line were evaluated using Cox Proportional Hazards and multivariable logistic regression models, respectively. Results: 2191 subjects started 2nd line therapy, 61.5% females. Switching from 1st line (56.4% NVP-based, 70.3% including thymidine-analogues) to 2nd line therapy occurred after mean of 4.1 years. 98.9% of patients started boosted PI with NRTI backbone (TDF+3TC/FTC 67.3%, AZT+3TC 18.5%, others 14.2%). There were 267 (12.0%) VF with a 5-year estimated probability of 15.0% (95% CI 13.2-16.9). Key determinants of VF were concomitant rifampicin use (aHR 2.50 [95% CI 1.54-4.05]) and clinical/immunological failure versus virologic failure as reason for switching therapy (aHR, 0.53 [0.33-0.86]). 138 of 267 (51.7%) subsequently achieved virologic re-suppression and predictors included HIV RNA levels at 2nd-line failure: +1 log higher aOR 0.59 [0.43-0.80], experiencing change within 2nd line ART before VF: aOR 0.17 [0.05-0.56], and more recent calendar year of 2nd line initiation: aOR 0.85 [0.75-0.94]. Conclusions: The effectiveness of current 2nd line ART regimens in SSA is good but challenged by interactions with TB therapy. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sarfo, Fred S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Castelnuovo, Barbara UNSPECIFIED orcid.org/0000-0001-7756-5032 UNSPECIFIED Fanti, Iuri UNSPECIFIED UNSPECIFIED UNSPECIFIED Feldt, Torsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Incardona, Francesca UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaiser, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Lwanga, Isaac UNSPECIFIED UNSPECIFIED UNSPECIFIED Marrone, Gaetano UNSPECIFIED UNSPECIFIED UNSPECIFIED Sonnerborg, Anders UNSPECIFIED orcid.org/0000-0001-8928-3374 UNSPECIFIED Tufa, Tafese B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zazzi, Maurizio UNSPECIFIED orcid.org/0000-0002-0344-6281 UNSPECIFIED De Luca, Andrea UNSPECIFIED orcid.org/0000-0002-9561-9193 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-150113
DOI:	10.1016/j.jinf.2019.03.003
Journal or Publication Title:	J. Infect.
Volume:	78
Number:	5
Page Range:	S. 402 - 409
Date:	2019
Publisher:	W B SAUNDERS CO LTD
Place of Publication:	LONDON
ISSN:	1532-2742
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DRUG-RESISTANCE; RISK-FACTORS; HIV; OUTCOMES; PHARMACOKINETICS; STROKE; LOPINAVIR/RITONAVIR; ADHERENCE; RIFABUTIN; CHILDREN Multiple languages Infectious Diseases Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15011