Adetunji Adedotun A, Achenbach Chad, Feinglass Joseph, Darin Kristin M, Scarsi Kimberly K, Ekong Ernest, Taiwo Babafemi O, Adewole Isaac F, Murphy Robert
Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
J Int Assoc Provid AIDS Care. 2013 Jul-Aug;12(4):236-40. doi: 10.1177/1545109712463733. Epub 2012 Nov 5.
We evaluated adult Nigerian patients with antiretroviral switch to second-line treatment with ritonavir-boosted protease inhibitor (PI/r)-based regimens due to virologic failure (confirmed HIV-1 RNA viral load [VL] >1000 copies/mL) during first-line antiretroviral therapy. Proportion of patients with VL >400 copies/mL and characteristics associated with nonsuppression during second-line treatment are described. Approximately 15% of patients (34 of 225) had VL >400 copies/mL at 1-year after treatment switch to PI/r-based regimens. In adjusted analyses, VL ≥5 log10 copies/mL at treatment switch (odds ratio [OR] 2.90 [confidence interval (CI) 1.21-6.93]); duration of first-line treatment after virologic failure >180 days (OR 2.56 [CI 1.0-6.54]); and PI/r regimen adherence <90% (OR 3.27 [CI 1.39-7.68]) were associated with VL >400 copies/mL at 1 year of second-line treatment. We therefore recommend that the maximum permissible time between suspicion of virologic failure and completion of antiretroviral treatment switch should not exceed 6 months when patients develop first-line antiretroviral failure in resource-limited settings.
我们评估了成年尼日利亚患者，这些患者在一线抗逆转录病毒治疗期间因病毒学失败（确诊的HIV-1 RNA病毒载量[VL]>1000拷贝/mL）而改用基于利托那韦增强蛋白酶抑制剂（PI/r）方案的二线治疗。描述了二线治疗期间病毒载量>400拷贝/mL的患者比例以及与病毒抑制未达标的相关特征。在改用基于PI/r方案治疗1年后，约15%的患者（225例中的34例）病毒载量>400拷贝/mL。在多因素分析中，治疗转换时病毒载量≥5 log10拷贝/mL（比值比[OR] 2.90 [置信区间(CI) 1.21 - 6.93]）；病毒学失败后一线治疗持续时间>180天（OR 2.56 [CI 1.0 - 6.54]）；以及PI/r方案依从性<90%（OR 3.27 [CI 1.39 - 7.68]）与二线治疗1年时病毒载量>400拷贝/mL相关。因此，我们建议，在资源有限的环境中，当患者出现一线抗逆转录病毒治疗失败时，从怀疑病毒学失败到完成抗逆转录病毒治疗转换的最长允许时间不应超过6个月。
