Failure of second-line ART common in South African patients with HIV

Second-line virological failure occurred frequently among patients with HIV in rural South Africa, according to findings published in Clinical Infectious Diseases.

“Despite clinical and public health gains following ART rollout, treatment failure of first-line nonnucleoside reverse transcriptase inhibitor-based ART is common, with up to 3 million HIV–infected patients estimated to receive second-line, boosted protease inhibitor-based ART by 2020,” Dami Collier, PhD student of the department of infection and immunity, University College London, and colleagues wrote. “Treatment failure on second-line ART is a major concern given poor, if any, access to further regimens in high-burden settings.”

Collier and colleagues performed a prospective cohort analysis of 101 patients, investigating risk factors for virological failure of bPI–based ART. The researchers defined virological failure as a plasma viral load greater than 1000 copies/mL for 6 months or more after initiating bPI–based ART, and estimated the cumulative incidence of virological failure.

Most (65%) patients were women, and the median age was 37.4 years. Overall, researchers reported, the incidence of virological failure in patients on second-line ART was 12.9 per 100 person-years (n = 23). The prevalence of virological failure at censoring was 17.8%. Of those 23 patients, 13 (56.5%) experienced resuppression after a median of 8 months (interquartile range, 2.8-16.8 months). Tuberculosis treatment was associated with virological failure, according to Collier and colleagues (subdistribution HR = 11.5; 95% CI, 3.92-33.74).

“In conclusion, this study found that second-line PI-based virological failure was common in this population accessing ART in rural South Africa under trial circumstances but recruited at the population level,” the researchers wrote. “Further research is needed to understand the mechanisms behind virological failure of bPI–ART in TB–coinfected patients. Novel approaches to optimize second-line ART in resource-limited settings are still urgently needed as this population is likely to grow rapidly, owing to the WHO 2015 guidelines to test and treat all people living with HIV.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.