Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study

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dc.contributor.authorMeintjes, Graeme
dc.contributor.authorDunn, Liezl
dc.contributor.authorCoetsee, Marla
dc.contributor.authorHislop, Michael
dc.contributor.authorLeisegang, Rory
dc.contributor.authorRegensberg, Leon
dc.contributor.authorMaartens, Gary
dc.date.accessioned2021-10-08T11:06:56Z
dc.date.available2021-10-08T11:06:56Z
dc.date.issued2015
dc.description.abstractBackground An increasing number of patients in Africa are experiencing virologic failure on second-line antiretroviral therapy (ART) and those who develop resistance to protease inhibitors (PI) will require third-line ART, but no data on the outcomes of third-line are available from the region. We assessed the virologic outcomes and survival of patients started on salvage ART in a Southern African private sector disease management programme.Methods Retrospective observational cohort study with linkage to the national death register. Adults (≥18years) who started salvage ART between July 2007 and December 2011 were included. Salvage ART was defined by inclusion of darunavir or tipranavir in an ART regimen after having failed another PI. For Kaplan–Meier (KM) analysis, patients were followed up until event, or censored at death (only for virologic outcomes), leaving the programme, or April 2014.Results152 patients were included. Subtype was known for 113 patients: 111 (98%) were infected with subtype C. All 152 had a genotype resistance test demonstrating major PI resistance mutations. Salvage drugs included were: darunavir/ritonavir (n=149), tipranavir/ritonavir (n=3), raltegravir (n=58), and etravirine (n=8). Median follow-up was 2.5years (IQR=1.5–3.3). 82.9% achieved a viral load ≤400 copies/ml and 71.1% ≤50 copies/ml. By the end of the study 17 (11.2%) of the patients had died. The KM estimate of cumulative survival was 87.2% at 2000days.ConclusionsVirologic suppression was comparable to that demonstrated in clinical trials and observational studies of salvage ART drugs conducted in other regions. Few deaths occurred during short term follow-up. Third-line regimens for patients with multidrug resistant subtype C HIV in Africa are virologically and clinically effective.
dc.identifier.apacitationMeintjes, G., Dunn, L., Coetsee, M., Hislop, M., Leisegang, R., Regensberg, L., & Maartens, G. (2015). Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study. <i>AIDS Research and Therapy</i>, 12(1), 174 - 177. http://hdl.handle.net/11427/35121en_ZA
dc.identifier.chicagocitationMeintjes, Graeme, Liezl Dunn, Marla Coetsee, Michael Hislop, Rory Leisegang, Leon Regensberg, and Gary Maartens "Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study." <i>AIDS Research and Therapy</i> 12, 1. (2015): 174 - 177. http://hdl.handle.net/11427/35121en_ZA
dc.identifier.citationMeintjes, G., Dunn, L., Coetsee, M., Hislop, M., Leisegang, R., Regensberg, L. & Maartens, G. 2015. Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study. <i>AIDS Research and Therapy.</i> 12(1):174 - 177. http://hdl.handle.net/11427/35121en_ZA
dc.identifier.issn1742-6405
dc.identifier.ris TY - Journal Article AU - Meintjes, Graeme AU - Dunn, Liezl AU - Coetsee, Marla AU - Hislop, Michael AU - Leisegang, Rory AU - Regensberg, Leon AU - Maartens, Gary AB - Background An increasing number of patients in Africa are experiencing virologic failure on second-line antiretroviral therapy (ART) and those who develop resistance to protease inhibitors (PI) will require third-line ART, but no data on the outcomes of third-line are available from the region. We assessed the virologic outcomes and survival of patients started on salvage ART in a Southern African private sector disease management programme.Methods Retrospective observational cohort study with linkage to the national death register. Adults (≥18years) who started salvage ART between July 2007 and December 2011 were included. Salvage ART was defined by inclusion of darunavir or tipranavir in an ART regimen after having failed another PI. For Kaplan–Meier (KM) analysis, patients were followed up until event, or censored at death (only for virologic outcomes), leaving the programme, or April 2014.Results152 patients were included. Subtype was known for 113 patients: 111 (98%) were infected with subtype C. All 152 had a genotype resistance test demonstrating major PI resistance mutations. Salvage drugs included were: darunavir/ritonavir (n=149), tipranavir/ritonavir (n=3), raltegravir (n=58), and etravirine (n=8). Median follow-up was 2.5years (IQR=1.5–3.3). 82.9% achieved a viral load ≤400 copies/ml and 71.1% ≤50 copies/ml. By the end of the study 17 (11.2%) of the patients had died. The KM estimate of cumulative survival was 87.2% at 2000days.ConclusionsVirologic suppression was comparable to that demonstrated in clinical trials and observational studies of salvage ART drugs conducted in other regions. Few deaths occurred during short term follow-up. Third-line regimens for patients with multidrug resistant subtype C HIV in Africa are virologically and clinically effective. DA - 2015 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - AIDS Research and Therapy LK - https://open.uct.ac.za PY - 2015 SM - 1742-6405 T1 - Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study TI - Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study UR - http://hdl.handle.net/11427/35121 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35121
dc.identifier.vancouvercitationMeintjes G, Dunn L, Coetsee M, Hislop M, Leisegang R, Regensberg L, et al. Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study. AIDS Research and Therapy. 2015;12(1):174 - 177. http://hdl.handle.net/11427/35121.en_ZA
dc.language.isoeng
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceAIDS Research and Therapy
dc.source.journalissue1
dc.source.journalvolume12
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12981-015-0081-8
dc.subject.otherInfectious Diseases
dc.subject.otherVirology
dc.subject.othermedical research
dc.subject.othertext mining
dc.subject.othervirology
dc.subject.otheralternative medicine
dc.subject.otherbioinformatics
dc.subject.othermedicine
dc.subject.otherbiology
dc.titleThird-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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