Acta Medica Iranica 2017. 55(4):233-240.

Assessing the Efficacy of Second-Line Antiretroviral Treatment for HIV Patients Failing First-Line Antiretroviral Therapy in Iran: A Cohort Study
Mehrnaz Rasooli-Nejad, Maryam Khazaee-Pool, Ladan Abbasian, Zahra Bayat Jozani, Sara Ahsani-Nasab, Banafsheh Moradmand Badie, Afsaneh Pargar, Gholamreza Esmaeeli Djavid

Abstract


There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.


Keywords


Antiretroviral therapy; HIV; Cohort studies; Iran

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References


Edathodu J, Ali B, Alrajhi AA. CD4 validation for the World Health Organization classification and clinical staging of HIV/AIDS in a developing country. Int J Infect 2009;13:243-6.

Annapoorna N, Rao GV, Reddy NS, Rambabu P, Rao KR. An Increased Risk of Osteoporosis during Acquired Immunodeficiency Syndrome. Int J Med Sci 2004;1:152-64.

Manasa J, Lessells RJ, Skingsley A, Naidu KK, Newell ML, McGrath N, de. High-levels of acquired drug resistance in adult patients failing first-line antiretroviral therapy in a rural HIV treatment programme in KwaZulu- Natal, South Africa. PLoS One 2013;8:e72152.

National AIDS Committee Secretariat, Ministry of Health and Medical Education.(updated March 2012) Islamic Republic of Iran Progress Report on Monitoring of the United Nations General Assembly Special Session (UNGASS) on HIV and AIDS.

Eluwa GI, Badru T, Akpoigbe KJ. Adverse drug reactions to antiretroviral therapy (ARVs): incidence, type and risk factors in Nigeria. BMC Cen ClinPharmacol 2012; 12:7.

Masenyetse LJ, Manda SO, Mwambi HG. An assessment of adverse drug reactions among HIV positive patients receiving antiretroviral treatment in South Africa. AIDS Res Ther 2015;12:6.

Pujades-Rodriguez M, O’Brien D, Humblet P, Calmy A.Second-line antiretroviral therapy in resource-limited settings: the experience of Medecins Sans Frontieres. AIDS 2008;22:1305-12.

vanZyl GU, van der Merwe L, Claassen M, Zeier M, Preiser W. Antiretroviral resistance patterns and factors associated with resistance in adult patients failing NNRTI-based regimens in the western cape, South Africa. J Med Virol 2011;83:1764-9.

Cooke GS, Tanser FC, Barnighausen TW, Newell ML.Population uptake of antiretroviral treatment through primary care in rural South Africa. BMC Public Health 2010;10:585.

World Health Organization, editor. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach: 2010 revision. Geneva, Switzerland: WHO., 2010.

Walker AS, Gibb DM. Monitoring of highly active antiretroviral therapy in HIV infection. CurrOpin Infect Dis 2011;24: 27-33.

Ajose O, Mookerjee S, Mills EJ, Boulle A, Ford N.Treatment outcomes of patients on second-line antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis. AIDS 2012;26:929-38.

Wasti SP, Simkhada P, Randall J, Freeman JV, van Teijlingen E. Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PloS One 2012;7:e35547.

Wakibi SN, Ng’ang’a ZW, Mbugua GG. Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya. AIDS Res Ther 2011;8:43.

Cauldbeck MB, O’Connor C, O’Connor MB, Saunders JA, Rao B, Mallesh VG, et al. Adherence to anti- retroviral therapy among HIV patients in Bangalore, India. AIDS Res Ther 2009;6:7.

Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Dam Jv. Adherence to antiretroviral therapy and its determinants amongst HIV patients in India. Indian J Med Res 2008;127:28-36.

Luma NH, Doualla MS, Choukem SP, Temfack E, Ashuntantang G, Joko HA, et al. Adverse drug reactions of Highly Active Antiretroviral Therapy (HAART) in HIV infected patients at the General Hospital, Douala, Cameroon: a cross sectional study. Pan Afr Med J 2012;12:87.

Eluwa GI, Badru T, Akpoigbe KJ. Adverse drug reactions to antiretroviral therapy (ARVs): incidence, type and risk factors in Nigeria. BMC Cen ClinPharmacol 2012;12:7.

Fan X, Mao Q, Zhou D, Lu Y, Xing J, Xu Y, et al. High diversity of hepatitis C viral quasispecies is associated with early virological response in patients undergoing antiviral therapy. Hepatology 2009;50:1765-72.

Braitstein P, Zala C, Yip B, Brinkhof MW, Moore D, Hogg RS, et al. Immunologic response to antiretroviral therapy in hepatitis C virus-coinfected adults in a population-based HIV/AIDS treatment program. J Infect Dis 2006;193:259-68.

Kumarasamy N, Venkatesh K, Devaleenal B, Poongulali S, Yepthomi T, Solomon S, et al. Safety, Tolerability, and efficacy of second-line generic protease inhibitor containing HAART after first-line failure among South Indian HIV-infected patients. J IntAssoc Physicians AIDS Care 2011;10:71-5.

Hart E, Curtis H, Wilkins E, Johnson M. National review of first treatment change after starting highly active antiretroviral therapy in antiretroviral naïve patients. HIV Med 2007;8:186-91.

Kumara SN, Vallabhaneni S. Reasons for modification of generic highly active antiretroviral therapeutic regimens among patients in southern India. J Acquir Immune DeficSyndr 2006;41:53-8.

Kiguba MN. Discontinuation and modification of highly active antiretroviral therapy in HIV-infected Ugandans: Prevalence and Associated factors. J Acquir Immune DeficSyndr 2007;45:218-23.

Mess OU, Eupene N, Anglaret Y. Antiretroviral treatment changes in adults from Cote d’lvoire: The role of tuberculosis and pregnancy. AIDS 2010;24:93-9.

Myat M, Meak W, Phonart B. Virologic and Immunologic Outcomes of the Second-Line Regimens of Antiretroviral Therapy Among HIV-Infected Patients in Thailand. J IntAssoc Physicians AIDS Care 2011;10:57-63.

Patel D, Desai M, Shah A, Dikshit RK. Early outcome of second line antiretroviral therapy in treatmentexperienced human immunodeficiency virus positive patients. PerspectClin Res 2013;4:215-20.

Levison JH, Orrell C, Losina E, Freedberg KA, Wood R.Early out comes and the virologicaleffect of delayed treatment switching to second- line therapy in antiretroviral roll-out programme in south africa. AntivirTher 2011;16:853-61.

Chkhartishvili N, Sharvadze L, Dvali N, et al. Virologic outcomes of second-line antiretroviral therapy in Eastern European country of Georgia. AIDS Res Ther 2014;11:18-24.

Aghokeng AF, Kouanfack C, Eymard-Duvernay S, Butel C, Edoul GE, Laurent C, et al. Virological outcome and patterns of HIV-1 drug resistance in patients with 36 months’ antiretroviral therapy experience in Cameroon. J Int AIDS Soc 2013;16:18004.

Soh CH, Oleske JM, Brady MT, Spector SA, Borkowsky W, Burchett SK, et al. Long-term effects of protease- inhibitor-based combination therapy on CD4 T-cell recovery in HIV-1-infected children and adolescents. Lancet 2003;362:2045-51.


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