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Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria.
Trans R Soc Trop Med Hyg. 2013 Oct; 107(10):608-14.TR

Abstract

BACKGROUND

Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART.

METHODS

In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months.

RESULTS

Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1-6.3) log10 copies/ml and 71 (6-610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002).

CONCLUSION

The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings.

Authors+Show Affiliations

Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23959002

Citation

Onyedum, Cajetan C., et al. "Profile of HIV-infected Patients Receiving Second-line Antiretroviral Therapy in a Resource-limited Setting in Nigeria." Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 107, no. 10, 2013, pp. 608-14.
Onyedum CC, Iroezindu MO, Chukwuka CJ, et al. Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria. Trans R Soc Trop Med Hyg. 2013;107(10):608-14.
Onyedum, C. C., Iroezindu, M. O., Chukwuka, C. J., Anyaene, C. E., Obi, F. I., & Young, E. E. (2013). Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 107(10), 608-14. https://doi.org/10.1093/trstmh/trt071
Onyedum CC, et al. Profile of HIV-infected Patients Receiving Second-line Antiretroviral Therapy in a Resource-limited Setting in Nigeria. Trans R Soc Trop Med Hyg. 2013;107(10):608-14. PubMed PMID: 23959002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria. AU - Onyedum,Cajetan C, AU - Iroezindu,Michael O, AU - Chukwuka,Chinwe J, AU - Anyaene,Chukwujekwu E, AU - Obi,Frank I, AU - Young,Ekenechukwu E, Y1 - 2013/08/19/ PY - 2013/8/21/entrez PY - 2013/8/21/pubmed PY - 2014/9/4/medline KW - Antiretroviral therapy KW - HIV KW - Resource-limited setting KW - Second-line KW - Treatment outcome SP - 608 EP - 14 JF - Transactions of the Royal Society of Tropical Medicine and Hygiene JO - Trans R Soc Trop Med Hyg VL - 107 IS - 10 N2 - BACKGROUND: Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART. METHODS: In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months. RESULTS: Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1-6.3) log10 copies/ml and 71 (6-610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002). CONCLUSION: The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings. SN - 1878-3503 UR - https://www.unboundmedicine.com/medline/citation/23959002/Profile_of_HIV_infected_patients_receiving_second_line_antiretroviral_therapy_in_a_resource_limited_setting_in_Nigeria_ L2 - https://academic.oup.com/trstmh/article-lookup/doi/10.1093/trstmh/trt071 DB - PRIME DP - Unbound Medicine ER -