Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
Trans R Soc Trop Med Hyg. 2013 Oct;107(10):608-14. doi: 10.1093/trstmh/trt071. Epub 2013 Aug 19.
Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART.
In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months.
Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1-6.3) log10 copies/ml and 71 (6-610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002).
The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings.
在资源有限的环境下，二线抗逆转录病毒治疗（ART）仅占总 ART 的不到 5%。我们描述了接受二线 ART 的尼日利亚患者的基线特征、转换原因和治疗结果。
在这项回顾性队列研究中，我们记录了治疗方案从非核苷类逆转录酶抑制剂（一线药物）转换为基于蛋白酶抑制剂的二线方案的 HIV 感染成年人的基线特征。随访时间为 12 个月。
在开始一线治疗的 4229 名患者中，186 名（4.4%）在平均 16.6±7.6 个月后转换为二线治疗。他们的平均年龄为 41.8±9.6 岁，59.1%为女性。转换时的中位（范围）病毒载量和 CD4 细胞计数分别为 4.7（4.1-6.3）log10 拷贝/ml 和 71（6-610）细胞/µl。转换的主要原因是病毒学失败（79.0%）。仅 55.4%和 36.6%的患者在 12 个月时有 CD4 细胞计数和病毒载量。在有可用数据的患者中，分别约 82%、79%和 82%在 3 个月、6 个月和 12 个月时达到病毒学抑制（p=0.81）。在有可用数据的患者中，3 个月、6 个月和 12 个月时分别有 82%、79%和 82%的患者达到病毒载量下降≥50%（p=0.81）。达到 CD4 细胞计数增加≥50%的患者比例从 3 个月时的 55.8%增加到 12 个月时的 78.6%（p=0.0002）。
转换为二线治疗的比例较低，但有可用数据的患者治疗结果良好。失访率较高。在资源有限的环境下，定期进行病毒载量监测、改善二线方案的可获得性/可负担性以及保持患者在治疗中应成为优先事项。
