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Assessing the Efficacy of Second-Line Antiretroviral Treatment for Hiv Patients Failing First-Line Antiretroviral Therapy in Iran: A Cohort Study Pubmed



Rasoolinejad M1, 2 ; Khazaeepool M3 ; Abbasian L1 ; Jozani ZB1 ; Ahsaninasab S1 ; Badie BM4 ; Pargar A1, 2 ; Djavid GE5
Authors
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Authors Affiliations
  1. 1. Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
  4. 4. Discipline of Public Health, School of Medicine, Flinders University, Flinders, SA, Australia
  5. 5. Academic Member of Academic Center for Education, Culture and Research, Tehran, Iran

Source: Acta Medica Iranica Published:2017


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. © 2017, Tehran University of Medical Sciences. All rights reserved.