title: Switch to second-line ART in West African routine care: incidence and reasons for switching.
abstract: In sub-Saharan Africa, while antiretroviral therapy (ART) becomes widely available, access to biological measurements to monitor patients under ART remains scarce, making the management of ART difficult. We described the management of switching to second-line ART where HIV care is provided mainly in secondary health-care structures, in the region of Segou, Mali. Of 865 patients, followed under ART for a median time of 15 months, 40 switched to second-line ART (3.3 switches/100 person years). Reason for switching was failure in 18 patients (after 21 months in median) and severe intolerance in 13 (after three months in median). Switching to second-line ART occurred earlier when motivated by intolerance than by failure. The low rate of switch compares well with other studies, but was low compared to the expected rate of failure, and may indicate that physicians are reluctant to switch ART when treatment options are limited.
authors.affiliation: Unite d'Epidemiologie des Maladies Emergentes, Institut Pasteur, Paris, France.
authors.forename: Jordi
authors.initials: J
authors.lastname: Landier
authors.forename: Alain
authors.initials: A
authors.lastname: Akonde
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pizzocolo
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Haidara
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Drabo
authors.forename: Louis
authors.initials: L
authors.lastname: Pizarro
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Yoann
authors.initials: Y
authors.lastname: Madec
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D057915:Drug Substitution / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents