|Second-line treatment in the Malawi antiretroviral programme: high early mortality, but good outcomes in survivors, despite extensive drug resistance at baseline.|
|PMID: 20345885 Owner: NLM Status: MEDLINE|
|OBJECTIVES: The Malawi antiretroviral therapy (ART) programme uses the public health approach to identify ART failure. Advanced disease progression may occur before switching to second-line ART. We report outcomes for patients evaluated and initiated on second-line treatment in Malawi.
METHODS: Patients meeting Malawi immunological or clinical criteria for ART failure in two large urban ART clinics were evaluated for virological failure (viral load >400 HIV-1 RNA copies/mL) and, if failure was confirmed, initiated on second-line ART (zidovudine/lamivudine/tenofovir/lopinavir/ritonavir). Patients were seen monthly and laboratory evaluations were performed quarterly and as needed. We performed logistic regression modelling to identify factors associated with mortality, mortality or new HIV illnesses, and virological suppression at 12 months.
RESULTS: Of the 109 patients with confirmed virological failure, five patients died prior to initiation, three declined switching and 101 patients initiated second-line treatment. Over 12 months, 10 additional patients died, 34 patients experienced 45 HIV-related events, and 19 patients experienced grade 3 or 4 toxicities. Among survivors, 85.2% had HIV-1 RNA<400 copies/mL at 12 months. While power to distinguish differences was limited, response rates were similar regardless of baseline resistance level. The median CD4 count increase was 142 cells/microL. World Health Organization clinical failure at baseline [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.14-10.59] and body mass index <18.5 (OR 4.43; 95% CI 1.15-17.12) were risk factors for death. Baseline CD4 count <50 cells/microL was associated with increased risk for death or morbidity at 12 months (OR 2.57; 95% CI 1.01-6.52).
CONCLUSIONS: Second-line treatment in Malawi was associated with substantial mortality, morbidity and toxicity but, among survivors, virological outcomes were favourable.
|M C Hosseinipour; J J Kumwenda; R Weigel; L B Brown; D Mzinganjira; B Mhango; J J Eron; S Phiri; J J van Oosterhout|
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|Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2010-03-19|
|Title: HIV medicine Volume: 11 ISSN: 1468-1293 ISO Abbreviation: HIV Med. Publication Date: 2010 Sep|
|Created Date: 2010-08-10 Completed Date: 2011-01-05 Revised Date: -|
Medline Journal Info:
|Nlm Unique ID: 100897392 Medline TA: HIV Med Country: England|
|Languages: eng Pagination: 510-8 Citation Subset: IM|
|University of North Carolina Project, Lilongwe, Malawi. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
analogs & derivatives
Anti-Retroviral Agents / adverse effects, therapeutic use*
Body Mass Index
CD4 Lymphocyte Count
Drug Resistance, Viral*
Drug Therapy, Combination / methods
Drug Toxicity / chemically induced, epidemiology*
HIV Infections / drug therapy*, etiology, mortality
HIV-1 / genetics*
Malawi / epidemiology
National Health Programs
Phosphonic Acids / adverse effects
RNA, Viral / analysis*
Statistics as Topic
Tuberculosis / complications
Zidovudine / adverse effects
|0/Anti-Retroviral Agents; 0/Phosphonic Acids; 0/RNA, Viral; 107021-12-5/tenofovir; 30516-87-1/Zidovudine; 73-24-5/Adenine|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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