ArticleJournal of acquired immune deficiency syndromes (1999)2012
Rates and predictors of failure of first-line antiretroviral therapy and switch to second-line ART in South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers, 8 of them syntheses that pooled it.
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Who cites it
96 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Onset and predictors of first-line antiretroviral therapy treatment failure among children in Ethiopia: a systematic review and meta-analysis.BMC pediatrics · 2024Pooled it
- Opportunistic infections among schoolchildren who were on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis.Frontiers in pediatrics · 2024Pooled it
- First line antiretroviral treatment failure and its association with drug substitution and sex among children in Ethiopia: systematic review and meta-analysis.Scientific reports · 2022Pooled it
- Point-of-care viral load tests to detect high HIV viral load in people living with HIV/AIDS attending health facilities.The Cochrane database of systematic reviews · 2022Pooled it
- Marked sex differences in all-cause mortality on antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis.Journal of the International AIDS Society · 2016Pooled it
- Sex differences in HIV outcomes in the highly active antiretroviral therapy era: a systematic review.AIDS research and human retroviruses · 2014Pooled it
- Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.PloS one · 2013Pooled it
- Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis.PloS one · 2013Pooled it
- Seemingly Unrelated Regression Analysis of the Cost and Health-Related Quality of Life Outcomes of the REVAMP Randomized Clinical Trial.Value in health regional issues · 2023Trial
- Reduced efficacy of HIV-1 integrase inhibitors in patients with drug resistance mutations in reverse transcriptase.Nature communications · 2020Trial
- Impact of peer support on virologic failure in HIV-infected patients on antiretroviral therapy - a cluster randomized controlled trial in Vietnam.BMC infectious diseases · 2016Trial
- First-line antiretroviral therapy with nevirapine versus lopinavir-ritonavir based regimens in a resource-limited setting.AIDS (London, England) · 2014Trial
- Changes to antiretroviral drug regimens during integrated TB-HIV treatment: results of the SAPiT trial.Antiviral therapy · 2014Trial
- Cost-effectiveness analysis of community-led HIV self-testing among key populations in Côte d'Ivoire, Mali, and Senegal.Journal of the International AIDS Society · 2024Article
- Second-line anti-retroviral treatment failure and its predictors among patients with HIV in Ethiopia: A systematic review and meta-analysis.PLOS global public health · 2024Article
- Investigating rates and predictors of viral blips, low-level viraemia and virological failure in the Australian HIV observational database.Tropical medicine & international health : TM & IH · 2024Article
- Biological parameters determining the effectiveness of monitoring of HIV / AIDS infected patients in Morocco.African health sciences · 2023Article
- Article
- Predictors of unsuppressed viral load among adults on follow up of antiretroviral therapy at selected public and private health facilities of Adama town: unmached case-control study.BMC public health · 2022Article
- Effect of Switching Antiretroviral Treatment Regimen in Patients With Drug-Resistant HIV-1 Infection: Retrospective Observational Cohort Study.JMIR public health and surveillance · 2022Observational
36 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
objectivesTo measure rates and predictors of virologic failure and switch to second-line antiretroviral therapy (ART) in South Africa.
design: Observational cohort study.
methodsWe included ART-naive adult patients initiated on public sector ART (January 2000 to July 2008) at 5 sites in South Africa who completed ≥6 months of follow-up. We estimated cumulative risk of virologic failure (viral load ≥400 copies/mL with confirmation above varying thresholds) and switching to second-line ART.
resultsNineteen thousand six hundred forty-five patients (29,935 person-years) had a median of 1.3 years of study follow-up (1.8 years on ART) and a median CD4 count of 93 (IQR: 39-155) cells per microliter at ART initiation. About 9.9% (4.5 per 100 person-years) failed ART in median 16 (IQR: 12-23) months since ART initiation, with median 2.7 months (IQR: 1.6-4.7) months between first elevated and confirmatory viral loads. By survival analysis, using a confirmatory threshold of 400 copies per milliliter, 16.9% [95% confidence interval (CI): 15.4% to 18.6%] failed by 5 years on ART, but only 7.8% (95% CI: 6.6% to 9.3%) using a threshold of 10,000. CD4 <25 versus 100-199 (adjusted HR: 1.60; 95% CI: 1.37 to 1.87), ART initiation viral load ≥1,000,000 versus <10,000, (1.32; 0.91 to 1.93), and 2+ gaps in care versus 0 (95% CI: 7.25; 4.95 to 10.6) were predictive of failure. Overall, 10.1% (95% CI: 9.0% to 11.4%) switched to second-line by 5 years on ART. Lower CD4 at failure and higher rate of CD4 decline were predictive of switch (decline 100% to 51% versus 25% to -25%, adjusted HR: 1.96; 95% CI: 1.35 to 2.85).
conclusionsIn resource-limited settings with viral load monitoring, virologic failure rates are highly sensitive to thresholds for confirmation. Despite clear guidelines there is considerable variability in switching failing patients, partially in response to immunologic status and postfailure evolution.
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