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Brief Report: Assessing the Association Between Changing NRTIs When Initiating Second-Line ART and Treatment Outcomes.
- Source :
-
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2018 Apr 01; Vol. 77 (4), pp. 413-416. - Publication Year :
- 2018
-
Abstract
- Background: After first-line antiretroviral therapy failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second line is uncertain due to the high potency of protease inhibitors used in second line.<br />Setting: We used clinical data from 6290 adult patients in South Africa and Zambia from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa cohort.<br />Methods: We included patients who initiated on standard first-line antiretroviral therapy and had evidence of first-line failure. We used propensity score-adjusted Cox proportional-hazards models to evaluate the impact of change in NRTI on second-line failure compared with remaining on the same NRTI in second line. In South Africa, where viral load monitoring was available, treatment failure was defined as 2 consecutive viral loads >1000 copies/mL. In Zambia, it was defined as 2 consecutive CD4 counts <100 cells/mm.<br />Results: Among patients in South Africa initiated on zidovudine (AZT), the adjusted hazard ratio for second-line virologic failure was 0.25 (95% confidence interval: 0.11 to 0.57) for those switching to tenofovir (TDF) vs. remaining on AZT. Among patients in South Africa initiated on TDF, switching to AZT in second line was associated with reduced second-line failure (adjusted hazard ratio = 0.35 [95% confidence interval: 0.13 to 0.96]). In Zambia, where viral load monitoring was not available, results were less conclusive.<br />Conclusions: Changing NRTI in second line was associated with better clinical outcomes in South Africa. Additional clinical trial research regarding second-line NRTI choices for patients initiated on TDF or with contraindications to specific NRTIs is needed.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
CD4 Lymphocyte Count
Female
Humans
Male
Middle Aged
South Africa
Treatment Outcome
Viral Load
Young Adult
Zambia
Anti-HIV Agents therapeutic use
Antiretroviral Therapy, Highly Active methods
HIV Infections drug therapy
Reverse Transcriptase Inhibitors therapeutic use
Salvage Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1944-7884
- Volume :
- 77
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of acquired immune deficiency syndromes (1999)
- Publication Type :
- Academic Journal
- Accession number :
- 29206723
- Full Text :
- https://doi.org/10.1097/QAI.0000000000001611