Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring
Data(s) |
2009
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Resumo |
BACKGROUND: In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia. DESIGN AND METHODS: Multicohort study of 17 ART programmes. All sites monitored CD4 cell count and had access to second-line ART and 10 sites monitored viral load. We compared times to switching, CD4 cell counts at switching and obtained adjusted hazard ratios for switching (aHRs) with 95% confidence intervals (CIs) from random-effects Weibull models. RESULTS: A total of 20 113 patients, including 6369 (31.7%) patients from 10 programmes with access to viral load monitoring, were analysed; 576 patients (2.9%) switched. Low CD4 cell counts at ART initiation were associated with switching in all programmes. Median time to switching was 16.3 months [interquartile range (IQR) 10.1-26.6] in programmes with viral load monitoring and 21.8 months (IQR 14.0-21.8) in programmes without viral load monitoring (P < 0.001). Median CD4 cell counts at switching were 161 cells/microl (IQR 77-265) in programmes with viral load monitoring and 102 cells/microl (44-181) in programmes without viral load monitoring (P < 0.001). Switching was more common in programmes with viral load monitoring during months 7-18 after starting ART (aHR 1.38; 95% CI 0.97-1.98), similar during months 19-30 (aHR 0.97; 95% CI 0.58-1.60) and less common during months 31-42 (aHR 0.29; 95% CI 0.11-0.79). CONCLUSION: In resource-limited settings, switching to second-line regimens tends to occur earlier and at higher CD4 cell counts in ART programmes with viral load monitoring compared with programmes without viral load monitoring. |
Formato |
application/pdf |
Identificador |
http://boris.unibe.ch/30207/1/ART-LINC%20AIDS%202009.pdf Keiser, Olivia; Keiser, O; Tweya, H; Boulle, A; Braitstein, P; Schechter, M; Brinkhof, Martin; Dabis, F; Tuboi, S; Sprinz, E; Pujades-Rodriguez, M; Calmy, A; Kumarasamy, N; Nash, D; Jahn, A; MacPhail, P; Lüthy, R; Wood, R; Egger, Matthias (2009). Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring. AIDS, 23(14), pp. 1867-74. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/QAD.0b013e32832e05b2 <http://dx.doi.org/10.1097/QAD.0b013e32832e05b2> doi:10.7892/boris.30207 info:doi:10.1097/QAD.0b013e32832e05b2 info:pmid:19531928 urn:issn:0269-9370 |
Idioma(s) |
eng |
Publicador |
Lippincott Williams & Wilkins |
Relação |
http://boris.unibe.ch/30207/ |
Direitos |
info:eu-repo/semantics/restrictedAccess |
Fonte |
Keiser, Olivia; Keiser, O; Tweya, H; Boulle, A; Braitstein, P; Schechter, M; Brinkhof, Martin; Dabis, F; Tuboi, S; Sprinz, E; Pujades-Rodriguez, M; Calmy, A; Kumarasamy, N; Nash, D; Jahn, A; MacPhail, P; Lüthy, R; Wood, R; Egger, Matthias (2009). Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring. AIDS, 23(14), pp. 1867-74. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/QAD.0b013e32832e05b2 <http://dx.doi.org/10.1097/QAD.0b013e32832e05b2> |
Palavras-Chave | #610 Medicine & health #360 Social problems & social services |
Tipo |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion PeerReviewed |