Tags

Type your tag names separated by a space and hit enter

Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières.
AIDS. 2008 Jul 11; 22(11):1305-12.AIDS

Abstract

OBJECTIVES

To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival.

DESIGN/METHODS

We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression.

RESULTS

Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl.

CONCLUSION

The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment.

Authors+Show Affiliations

Epicentre, Paris, France. mar.pujades@epicentre.msf.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18580610

Citation

Pujades-Rodríguez, Mar, et al. "Second-line Antiretroviral Therapy in Resource-limited Settings: the Experience of Médecins Sans Frontières." AIDS (London, England), vol. 22, no. 11, 2008, pp. 1305-12.
Pujades-Rodríguez M, O'Brien D, Humblet P, et al. Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières. AIDS. 2008;22(11):1305-12.
Pujades-Rodríguez, M., O'Brien, D., Humblet, P., & Calmy, A. (2008). Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières. AIDS (London, England), 22(11), 1305-12. https://doi.org/10.1097/QAD.0b013e3282fa75b9
Pujades-Rodríguez M, et al. Second-line Antiretroviral Therapy in Resource-limited Settings: the Experience of Médecins Sans Frontières. AIDS. 2008 Jul 11;22(11):1305-12. PubMed PMID: 18580610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières. AU - Pujades-Rodríguez,Mar, AU - O'Brien,Daniel, AU - Humblet,Pierre, AU - Calmy,Alexandra, PY - 2008/6/27/pubmed PY - 2008/8/22/medline PY - 2008/6/27/entrez SP - 1305 EP - 12 JF - AIDS (London, England) JO - AIDS VL - 22 IS - 11 N2 - OBJECTIVES: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival. DESIGN/METHODS: We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression. RESULTS: Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl. CONCLUSION: The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment. SN - 1473-5571 UR - https://www.unboundmedicine.com/medline/citation/18580610/Second_line_antiretroviral_therapy_in_resource_limited_settings:_the_experience_of_Médecins_Sans_Frontières_ L2 - https://doi.org/10.1097/QAD.0b013e3282fa75b9 DB - PRIME DP - Unbound Medicine ER -