Mortality after failure of antiretroviral therapy in sub-Saharan Africa
Open Access
- 12 January 2010
- journal article
- research article
- Published by Wiley in Tropical Medicine & International Health
- Vol. 15 (2), 251-258
- https://doi.org/10.1111/j.1365-3156.2009.02445.x
Abstract
Objective To assess the outcome of patients who experienced treatment failure with antiretrovirals in sub‐Saharan Africa. Methods Analysis of 11 antiretroviral therapy (ART) programmes in sub‐Saharan Africa. World Health Organization (WHO) criteria were used to define treatment failure. All ART‐naive patients aged ≥16 who started with a non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐based regimen and had at least 6 months of follow‐up were eligible. For each patient who switched to a second‐line regimen, 10 matched patients who remained on a non‐failing first‐line regimen were selected. Time was measured from the time of switching, from the corresponding time in matched patients, or from the time of treatment failure in patients who remained on a failing regimen. Mortality was analysed using Kaplan–Meier curves and random‐effects Cox models. Results Of 16 591 adult patients starting ART, 382 patients (2.3%) switched to a second‐line regimen. Another 323 patients (1.9%) did not switch despite developing immunological or virological failure. Cumulative mortality at 1 year was 4.2% (95% CI 2.2–7.8%) in patients who switched to a second‐line regimen and 11.7% (7.3%–18.5%) in patients who remained on a failing first‐line regimen, compared to 2.2% (1.6–3.0%) in patients on a non‐failing first‐line regimen (P < 0.0001). Differences in mortality were not explained by nadir CD4 cell count, age or differential loss to follow up. Conclusions Many patients who meet criteria for treatment failure do not switch to a second‐line regimen and die. There is an urgent need to clarify the reasons why in sub‐Saharan Africa many patients remain on failing first‐line ART.Keywords
This publication has 18 references indexed in Scilit:
- Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoringAIDS, 2009
- Incidence and Predictors of Death, Retention, and Switch to Second‐Line Regimens in Antiretroviral‐Treated Patients in Sub‐Saharan African Sites with Comprehensive Monitoring AvailabilityClinical Infectious Diseases, 2009
- Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settingsBulletin of the World Health Organization, 2008
- Observational Studies Analyzed Like Randomized ExperimentsEpidemiology, 2008
- Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans FrontièresAIDS, 2008
- Public-Health and Individual Approaches to Antiretroviral Therapy: Township South Africa and Switzerland ComparedPLoS Medicine, 2008
- Eearly loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countriesBulletin of the World Health Organization, 2008
- Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and FacilitatorsPLoS Medicine, 2006
- Cohort Profile: Antiretroviral Therapy in Lower Income Countries (ART-LINC): international collaboration of treatment cohortsInternational Journal of Epidemiology, 2005
- Efficacy of Antiretroviral Therapy Programs in Resource‐Poor Settings: A Meta‐analysis of the Published LiteratureClinical Infectious Diseases, 2005