ArticleJournal of acquired immune deficiency syndromes (1999)2016
Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network.
Article in Journal of acquired immune deficiency syndromes (1999), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 13 citations in OpenAlex.
- Biological parameters determining the effectiveness of monitoring of HIV / AIDS infected patients in Morocco.African health sciences · 2023Article
- Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022Article
- Patient and health facility attributes associated with retention and virologic suppression in private for-profit health facilities in Nigeria.AIDS research and therapy · 2022Article
- HIV Care continuum Outcomes: Can Ethiopia Meet the UNAIDS 90-90-90 Targets?Ethiopian journal of health sciences · 2020Article
- Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study.BMJ open · 2018Article
- Durability of Efavirenz Compared With Boosted Protease Inhibitor-Based Regimens in Antiretroviral-Naïve Patients in the Caribbean and Central and South America.Open forum infectious diseases · 2018Article
- Effectiveness and Risk Factors for Virological Outcome of Raltegravir-Based Therapy for Treatment-Experienced HIV-Infected Patients.Drugs in R&D · 2017Article
- A decade of HAART in Latin America: Long term outcomes among the first wave of HIV patients to receive combination therapy.PloS one · 2017Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 6 countries.
Funding
Abstract
backgroundHIV-infected persons in resource-limited settings may experience high rates of antiretroviral therapy (ART) change, particularly because of toxicity or other nonfailure reasons. Few reports address patient outcomes after these modifications.
methodsHIV-infected adults from the 7 Caribbean, Central and South America network clinical cohorts who modified >1 drug from the first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. We assessed cumulative incidence of, and factors associated with, death, virologic failure (VF), and regimen change after starting ART-2.
resultsFive thousand five hundred sixty-five ART-naive highly active ART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 because of toxicity and 11% because of failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4%, and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio = 1.5 vs. failure, 95% confidence interval: 1.0 to 2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at the start of ART-2, and starting ART-2 because of failure (adjusted hazard ratio = 2.1 vs. toxicity, 95% confidence interval: 1.5 to 2.8).
conclusionsAmong patients modifying the first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success.
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