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USE OF THIRD LINE ANTIRETROVIRAL THERAPY IN LATIN AMERICA
Author
Affilliation
Fundación Huésped. Buenos Aires, Argentina.
Vanderbilt University. Nashville, TN, USA.
Vanderbilt University. Nashville, TN, USA.
Pan American Health Organization. Washington, DC, USA.
Pan American Health Organization. Washington, DC, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Universidad de Chile. Santiago, Chile.
Instituto Hondureño de Seguridad Social and Hospital Escuela. Tegucigalpa, Honduras
Instituto Nacional de Ciencias Médicas y Nutrición. Mexico City, MC, Mexico.
Instituto de Medicina Tropical Alexander Von Humboldt. Lima, Peru.
Fundación Huésped. Buenos Aires, Argentina.
Coordinación Sida, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires. Buenos Aires, Argentina.
Fundación Huésped. Buenos Aires, Argentina.
Vanderbilt University. Nashville, TN, USA.
Fundación Huésped. Buenos Aires, Argentina.
Vanderbilt University. Nashville, TN, USA.
Vanderbilt University. Nashville, TN, USA.
Pan American Health Organization. Washington, DC, USA.
Pan American Health Organization. Washington, DC, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Universidad de Chile. Santiago, Chile.
Instituto Hondureño de Seguridad Social and Hospital Escuela. Tegucigalpa, Honduras
Instituto Nacional de Ciencias Médicas y Nutrición. Mexico City, MC, Mexico.
Instituto de Medicina Tropical Alexander Von Humboldt. Lima, Peru.
Fundación Huésped. Buenos Aires, Argentina.
Coordinación Sida, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires. Buenos Aires, Argentina.
Fundación Huésped. Buenos Aires, Argentina.
Vanderbilt University. Nashville, TN, USA.
Fundación Huésped. Buenos Aires, Argentina.
Abstract
Background: Access to highly active antiretroviral therapy (HAART) is expanding in Latin America. Many patients require
second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART,
essential for program planning, is not known.
Methods: Antiretroviral-naı¨ve patients $18 years who started first HAART after January 1, 2000 in Caribbean, Central and
South America Network (CCASAnet) sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials
participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or
raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART.
Results: Of 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3%) failed a second line regimen and 44 (0.8%)
received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three
and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line
included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18–2.00, p = 0.001), younger age (HR = 2.76 for
20 vs. 40 years, 95% CI 1.86–4.10, p,0.001), and prior AIDS (HR = 2.17, 95% CI 1.62–2.90, p,0.001).
Conclusions: Third line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting
HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third
line regimens is warranted.
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