Autor | Cardoso, Sandra Wagner | |
Autor | Luz, Paula Mendes | |
Autor | Velasque, Luciane de Souza | |
Autor | Torres, Thiago Silva | |
Autor | Tavares, Isabel Cristina Ferreira | |
Autor | Ribeiro, Sayonara Rocha | |
Autor | Moreira, Ronaldo Ismério | |
Autor | Santos, Valdiléa Gonçalves Veloso dos | |
Autor | Moore, Richard D. | |
Autor | Grinsztejn, Beatriz | |
Data de acesso | 2015-07-15T11:58:36Z | |
Data de disponibilização | 2015-07-15T11:58:36Z | |
Data do publicação | 2014 | |
Citação | CARDOSO, Sandra Wagner et al. Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil. BMC Infectious Diseases, v.14, n.699, p.1-11, 2014. | pt_BR |
ISSN | 1471-2334 | |
URI | https://www.arca.fiocruz.br/handle/icict/11359 | |
Fomento | BG and PML acknowledge funding from the National Council of
Technological and Scientific Development (CNPq) and the Research Funding
Agency of the State of Rio de Janeiro (FAPERJ). | pt_BR |
Idioma | eng | pt_BR |
Editor | BioMed Central | pt_BR |
Direito Autoral | open access | pt_BR |
Título | Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil | pt_BR |
Tipo do documento | Article | pt_BR |
DOI | 10.1186/s12879-014-0699-5 | |
Resumo em Inglês | Background: World-wide, the notable expansion of HIV/AIDS treatment programs in resource-limited settings has
lead to an increasing number of patients in need of second-line cART. To adequately address and prepare for this
scenario, critical assessments of the outcomes of second-line cART are particularly relevant in settings where
monitoring strategies may be inadequate. We evaluated virologic outcomes of second-line combination antiretroviral
therapy (cART) among HIV-infected individuals from Brazil.
Methods: This study was conducted at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo
Cruz, at Rio de Janeiro, Brazio. For this study we included all patients who started first-line and second-line cART
between 2000 and 2013. Second-line cART required a switch in the anchor drug of first-line cART. We evaluated time
from second-line start to virologic failure and factors associated with increased risk of failure using multivariable Cox
proportional hazards regression models.
Results: Among the 1,311 patients who started first-line cART a total of 386 patients (29.5%) initiated second-line cART,
out of which 35.0% and 60.6% switched from their first-line to their second-line cART when their HIV RNA was
undetectable and after documented virologic failure, respectively. At second line cART initiation, median age was
38 years [interquartile range (IQR): 31-45years]. Median CD4 count was significantly different for patients starting
second-line cART undetectable [412 cells/mm3 (IQR: 240-617)] compared to those starting second-line cART after
documented virologic failure [230 cells/mm3 (IQR: 118-322.5)] (p < 0.01). Median time from second-line cART initiation
to failure was also significantly different for patients starting second-line cART undetectable compared to those who
with documented virologic failure (log-rank test p < 0.01). Multivariable Cox models showed that younger age, lower
education, and HIV RNA level were independently associated with an increased hazard of second-line failure among
those with documented virologic failure at start of second-line cART.
Conclusions: We have shown that in a middle-income country with universal access to cART, having a detectable HIV
RNA at the start of second-line cART as well as younger age and lower education negatively impact second-line
outcomes. Our findings could guide HIV treatment efforts as to which strategies would help maximize the durability of
these regimens. | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Departamento de Matemática e Estatística. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Afiliação | Johns Hopkins University. Baltimore, MD, United States of America | pt_BR |
Afiliação | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil | pt_BR |
Palavras-chave em inglês | HIV | pt_BR |
Palavras-chave em inglês | Brazil | pt_BR |
Palavras-chave em inglês | Anti-Retroviral Agents | pt_BR |
Palavras-chave em inglês | Statistical Analysis | pt_BR |
Palavras-chave em inglês | cART | pt_BR |
DeCS | HIV | pt_BR |
DeCS | Brasil | pt_BR |
DeCS | Antirretrovirais | pt_BR |
DeCS | Análise Estatística | pt_BR |
e-ISSN | 1471-2334 | |