ArticleJournal of acquired immune deficiency syndromes (1999)2020
Increased Mortality With Delayed and Missed Switch to Second-Line Antiretroviral Therapy in South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review.JAMA network open · 2023Pooled it
- Improving reporting of observational studies of interventions: The TARGET guideline.PLoS medicine · 2025Article
- Virological failure in a pediatric cohort on a dolutegravir based regimen: a retrospective study in northwest Ethiopia, 2017-2023.Frontiers in pediatrics · 2025Article
- Clinical Outcomes After Viremia Among People Receiving Dolutegravir vs Efavirenz-Based First-line Antiretroviral Therapy in South Africa.Open forum infectious diseases · 2023Article
- Article
- Virological failure and treatment switch after ART initiation among people living with HIV with and without routine viral load monitoring in Asia.Journal of the International AIDS Society · 2022Article
- Detection of HIV Virologic Failure and Switch to Second-Line Therapy: A Systematic Review and Meta-analysis of Data From Sub-Saharan Africa.Open forum infectious diseases · 2022Article
- Article
- Patterns and prognosis of holding regimens for people living with HIV in Asian countries.PloS one · 2022Article
- Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis.AIDS research and therapy · 2021Article
- Article
- Urgent need to improve programmatic management of patients with HIV failing first-line antiretroviral therapy.Public health action · 2020Article
- Improved Viral Suppression With Streamlined Care in the SEARCH Study.Journal of acquired immune deficiency syndromes (1999) · 2020Article
- Treatment modification after second-line failure among people living with HIV in the Asia-Pacific.Antiviral therapy · 2020Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundAfter failure of first-line antiretroviral therapy (ART) in the public sector, delayed or missed second-line ART switch is linked with poor outcomes in patients with advanced HIV.
settingWe investigated delayed or missed second-line ART switch after confirmed virologic failure in the largest private sector HIV cohort in Africa.
methodsWe included HIV-infected adults with confirmed virologic failure after 6 months of nonnucleoside reverse-transcriptase inhibitor-based ART. We estimated the effect of timing of switch on the hazard of death using inverse probability of treatment weighting of marginal structural models. We adjusted for time-dependent confounding of CD4 count, viral load, and visit frequency.
resultsFive thousand seven hundred forty-eight patients (53% female) with confirmed virologic failure met inclusion criteria; the median age was 40 [interquartile range (IQR): 35-47], advanced HIV was present in 48% and the prior duration of nonnucleoside reverse-transcriptase inhibitor-based ART was 1083 days (IQR: 665-1770). Median time to confirmation of virologic failure and to second-line switch was 196 (IQR: 136-316) and 220 days (IQR: 65-542), respectively. Switching to second-line ART after confirmed failure compared with remaining on first-line ART reduced risk of subsequent death [adjusted hazard ratio: 0.47 (95% confidence interval: 0.36 to 0.63)]. Compared with patients who experienced delayed switch, those switched immediately had a lower risk of death, regardless of CD4 cell count.
conclusionsDelayed or missed switch to second-line ART after confirmed first-line ART failure is common in the South African private sector and associated with mortality. Novel interventions to minimize switch delay should be tested and not limited to those with advanced disease at treatment failure.
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