ArticleJournal of acquired immune deficiency syndromes (1999)2019
Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes.
Article in Journal of acquired immune deficiency syndromes (1999), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Viral load suppression rate of third-line antiretroviral therapy and its association with gender among HIV patients after second-line treatment failure in Africa: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- Virological outcomes of third-line antiretroviral therapy in a global context: a systematic reviews and meta-analysis.AIDS research and therapy · 2024Pooled it
- Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa.Journal of the International AIDS Society · 2021Trial
- Third-line antiretroviral therapy in low-income and middle-income countries (ACTG A5288): a prospective strategy study.The lancet. HIV · 2019Trial
- Article
- Major protease inhibitor drug resistance mutations among patients with virological failure on second-line antiretroviral therapy in Zimbabwe: a retrospective cross-sectional study.Virology journal · 2026Article
- Article
- Illustrations of Coping and Mental Well-Being of Adolescents Living with HIV in Cape Town, South Africa During COVID: A Photovoice Study.International journal of environmental research and public health · 2024Article
- Health Workers' Responses to COVID-19 Pandemic's Impact on Service Delivery to Adolescents in HIV Treatment in Cape Town, South Africa: A Qualitative Study.Healthcare (Basel, Switzerland) · 2024Article
- A multidisciplinary approach for people with HIV failing antiretroviral therapy in South Africa.Southern African journal of HIV medicine · 2024Article
- Virologic outcomes with tenofovir-lamivudine-dolutegravir in adults failing PI-based second-line ART.Southern African journal of HIV medicine · 2024Article
- HIV Drug Resistance Mutations and Subtype Profiles among Pregnant Women of Ho Chi Minh City, South Vietnam.Viruses · 2023Article
- Predictors of virologic outcome among people living with HIV who continue a protease inhibitor-based antiretroviral regimen following virologic failure with no or limited resistance.AIDS research and therapy · 2023Article
- Factors associated with adherence and viral suppression among patients on second-line antiretroviral therapy in an urban HIV program in Kenya.SAGE open medicine · 2023Article
- Evaluation of Circulating and Archived HIV-1 Integrase Drug-Resistance Variants among Patients on Third-Line ART in Cameroon: Implications for Dolutegravir-Containing Regimens in Resource-Limited Settings.Microbiology spectrum · 2022Article
- Third-line antiretroviral therapy, including raltegravir (RAL), darunavir (DRV/r) and/or etravirine (ETR), is well tolerated and achieves durable virologic suppression over 144 weeks in resource-limited settings: ACTG A5288 strategy trial.Journal of the International AIDS Society · 2022Article
- Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa.Drug and alcohol dependence · 2022Article
- HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: A systematic review and meta-analysis.PLOS global public health · 2022Article
- Delays in third-line antiretroviral therapy and outcomes in North West province.Southern African journal of HIV medicine · 2022Article
- Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda.AIDS research and therapy · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundThe World Health Organization recommends that antiretroviral therapy (ART) programs in resource-limited settings develop third-line ART policies. South Africa developed a national third-line ART program for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitor-based ART and second-line protease inhibitor (PI)-based ART. We report on this program.
methodsThird-line ART in South Africa is accessed through a national committee that assesses eligibility and makes individual regimen recommendations. Criteria for third-line include the following: ≥1 year on PI-based ART with virologic failure, despite adherence optimization, and genotypic antiretroviral resistance test showing PI resistance. We describe baseline characteristics and resistance patterns of this cohort and present longitudinal data on virological suppression rates.
resultsBetween August 2013 and July 2014, 144 patients were approved for third-line ART. Median age was 41 years [interquartile range (IQR): 19-47]; 60% were women (N = 85). Median CD4 count and viral load were 172 (IQR: 128-351) and 14,759 (IQR: 314-90,378), respectively. About 2.8% started PI-based ART before 2004; 11.1% from 2004 to 2007; 31.3% from 2008 to 2011; and 6.3% from 2012 to 2014 (48.6% unknown start date). Of the 144 patients, 97% and 98% had resistance to lopinavir and atazanavir, respectively; 57% had resistance to darunavir. All were initiated on a regimen containing darunavir, with raltegravir in 101, and etravirine in 33. Among those with at least 1 viral load at least 6 months after third-line approval (n = 118), a large proportion (83%, n = 98) suppressed to <1000 copies per milliliter, and 79% (n = 93) to <400 copies per milliliter.
conclusionA high proportion of third-line patients with follow-up viral loads are virologically suppressed.
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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.