Evidence map›Paper›PMID 28329393›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017

Virological Outcomes of Second-line Protease Inhibitor-Based Treatment for Human Immunodeficiency Virus Type 1 in a High-Prevalence Rural South African Setting: A Competing-Risks Prospective Cohort Analysis.

Dami Collier, Collins Iwuji, Anne Derache, Tulio de Oliveira, Nonhlanhla Okesola, Alexandra Calmy, Francois Dabis, Deenan Pillay, Ravindra K Gupta, French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) Study Group

Registry-linked trialOpen access · bronzeAbstract read
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01509508 (A Cluster Randomised Trial Comparing the Impact of Immediate Versus South African Recommendations Guided ART Initiation on HIV Incidence. The ARNS 12249 TasP), which is not on this map. Cited by 28 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01509508 nacompletednot on this map

A Cluster Randomised Trial Comparing the Impact of Immediate Versus South African Recommendations Guided ART Initiation on HIV Incidence. The ARNS 12249 TasP (Treatment as Prevention) Trial in Hlabisa Sub-district, KwaZulu-Natal, South Africa.

TypeinterventionalSponsorANRS, Emerging Infectious DiseasesRan2012 to 2016Enrolled28,153ConditionsHIV InfectionArmsImmediate ARV treatment initiation with TDF/FTC/EFV, South African recommendation guided ARV (TDF/FTC/EFV) initiation
3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 4 countries.

Dami CollierDepartment of Infection and Immunity, University College London, United Kingdom.
Collins IwujiAfrica Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Anne DeracheAfrica Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Tulio de OliveiraAfrica Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Nonhlanhla OkesolaAfrica Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Alexandra CalmyGeneva University Hospital, HIV Unit, Department of Internal Medicine, Switzerland.
Francois DabisINSERM U1219-Centre Inserm Bordeaux Population Health, Université de Bordeaux, France.
Deenan PillayDepartment of Infection and Immunity, University College London, United Kingdom.
Ravindra K GuptaDepartment of Infection and Immunity, University College London, United Kingdom.
French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) Study Group
Africa Health Research Institute · ZAUniversity College London · GBInserm · FRUniversity Hospital of Geneva · CH

Funding

Wellcome Trust 206440
6 · The paper itself

Abstract

Background: Second-line antiretroviral therapy (ART) based on ritonavir-boosted protease inhibitors (bPIs) represents the only available option after first-line failure for the majority of individuals living with human immunodeficiency virus (HIV) worldwide. Maximizing their effectiveness is imperative. Methods: This cohort study was nested within the French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. We prospectively investigated risk factors for virological failure (VF) of bPI-based ART in the combined study arms. VF was defined by a plasma viral load >1000 copies/mL ≥6 months after initiating bPI-based ART. Cumulative incidence of VF was estimated and competing risk regression was used to derive the subdistribution hazard ratio (SHR) of the associations between VF and patient clinical and demographic factors, taking into account death and loss to follow-up. Results: One hundred one participants contributed 178.7 person-years of follow-up. Sixty-five percent were female; the median age was 37.4 years. Second-line ART regimens were based on ritonavir-boosted lopinavir, combined with zidovudine or tenofovir plus lamivudine or emtricitabine. The incidence of VF on second-line ART was 12.9 per 100 person-years (n = 23), and prevalence of VF at censoring was 17.8%. Thirteen of these 23 (56.5%) virologic failures resuppressed after a median of 8.0 months (interquartile range, 2.8-16.8 months) in this setting where viral load monitoring was available. Tuberculosis treatment was associated with VF (SHR, 11.50 [95% confidence interval, 3.92-33.74]; P < .001). Conclusions: Second-line VF was frequent in this setting. Resuppression occurred in more than half of failures, highlighting the value of viral load monitoring of second-line ART. Tuberculosis was associated with VF; therefore, novel approaches to optimize the effectiveness of PI-based ART in high-tuberculosis-burden settings are needed. Clinical Trials Registration: NCT01509508.

Indexed as

GenotypeViral LoadAdolescentAdultAgedAged, 80 and overAnti-HIV AgentsFemaleHIV-1HIV InfectionsHIV Protease InhibitorsHumansMaleMiddle AgedPrevalenceProspective StudiesAnti-HIV AgentsHIV Protease Inhibitorsantiretroviral therapyHIVprotease inhibitorsecond linevirological failure

Identifiers

PMID28329393
PMCPMC5439490
OpenAlexW2595821153

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.