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Effect of therapy switch on time to second-line antiretroviral treatment failure in HIV-infected patients

Journal article
Authors A. Haggblom
M. Santacatterina
U. Neogi
Magnus Gisslén
B. Hejdeman
L. Flamholc
A. Sonnerborg
Published in Plos One
Volume 12
Issue 7
ISSN 1932-6203
Publication year 2017
Published at Institute of Biomedicine, Department of Infectious Medicine
Language en
Links doi.org/10.1371/journal.pone.018014...
Keywords DRUG-RESISTANCE, VIRAL LOAD, VIROLOGICAL RESPONSE, DISEASE PROGRESSION, COHORT, REGRESSION, MORTALITY, OUTCOMES, TYPE-1, WEB
Subject categories Infectious Medicine

Abstract

Background Switch from first line antiretroviral therapy (ART) to second-line ART is common in clinical practice. However, there is limited knowledge of to which extent different reason for therapy switch are associated with differences in long-term consequences and sustainability of the second line ART. Data from 869 patients with 14601 clinical visits between 1999-2014 were derived from the national cohort database. Reason for therapy switch and viral load (VL) levels at first-line ART failure were compared with regard to outcome of second line ART. Using the Laplace regression model we analyzed the median, 10th, 20th, 30th and 40th percentile of time to viral failure (VF). Most patients (n = 495; 57.0%) switched from first-line to second-line ART without VF. Patients switching due to detectable VL with (n = 124; 14.2%) or without drug resistance mutations (DRM) (n = 250; 28.8%) experienced VF to their second line regimen sooner (median time, years: 3.43 (95% CI 2.90-3.96) and 3.20 (95% 2.65-3.75), respectively) compared with those who switched without VF (4.53 years). Furthermore level of VL at first-line ART failure had a significant impact on failure of second-line ART starting after 2.5 years of second-line ART. In the context of life-long therapy, a median time on second line ART of 4.53 years for these patients is short. To prolong time on second-line ART, further studies are needed on the reasons for therapy changes. Additionally patients with a high VL at first-line VF should be more frequently monitored the period after the therapy switch.

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