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OUTCOMES OF SECOND-LINE COMBINATION ANTIRETROVIRAL THERAPY FOR HIV-INFECTED PATIENTS: A COHORT STUDY FROM RIO DE JANEIRO, BRAZIL
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Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
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
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Johns Hopkins University. Baltimore, MD, United States of America
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
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
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Johns Hopkins University. Baltimore, MD, United States of America
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil
Abstract
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.
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