ArticleJournal of acquired immune deficiency syndromes (1999)2019
A Clinical Prediction Rule for Protease Inhibitor Resistance in Patients Failing Second-Line Antiretroviral Therapy.
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 8 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis.PloS one · 2019Pooled it
- Third-line antiretroviral therapy in low-income and middle-income countries (ACTG A5288): a prospective strategy study.The lancet. HIV · 2019Trial
- Virologic outcomes with tenofovir-lamivudine-dolutegravir in adults failing PI-based second-line ART.Southern African journal of HIV medicine · 2024Article
- Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa's Experience and Future Directions for Resource-Limited Settings.Diagnostics (Basel, Switzerland) · 2023Review
- 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
- Article
- Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update.Southern African journal of HIV medicine · 2020Article
- Initial Antiretroviral Third-Drug Class and Time to Loss of Virologic Suppression: A Real-World Colombian Cohort Study.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundMost adults with virological failure on second-line antiretroviral therapy (ART) in resource-limited settings have no major protease inhibitor (PI) resistance mutations. Therefore, empiric switches to third-line ART would waste resources. Genotypic antiretroviral resistance testing (GART) is expensive and has limited availability. A clinical prediction rule (CPR) for PI resistance could rationalize access to GART.
settingA private sector ART cohort, South Africa.
methodsWe identified adults with virologic failure on ritonavir-boosted lopinavir/atazanavir-based ART and GART. We constructed a multivariate logistic regression model including age, sex, PI duration, short-term adherence (using pharmacy claims), concomitant CYP3A4-inducing drugs, and viral load at time of GART. We selected variables for the CPR using a stepwise approach and internally validated the model by bootstrapping.
results148/339 (44%) patients had PI resistance (defined as ≥ 1 major resistance mutation to current PI). The median age was 42 years (interquartile range 36-48), 212 (63%) were females, 308 (91%) were on lopinavir/ritonavir, and median PI duration was 2.6 years (interquartile range 1.6-4.7). Variables associated with PI resistance and included in the CPR were age {adjusted odds ratio (aOR) 1.96 (95% confidence interval [CI]: 1.42 to 2.70) for 10-year increase}, PI duration (aOR 1.14 [95% CI: 1.03 to 1.26] per year), and adherence (aOR 1.22 [95% CI: 1.12 to 1.33] per 10% increase). The CPR model had a c-statistic of 0.738 (95% CI: 0.686 to 0.791).
conclusionsOlder patients with high adherence and prolonged PI exposure are most likely to benefit from GART to guide selection of a third-line ART regimen. Our CPR to select patients for GART requires external validation before implementation.
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