title: Optimizing treatment switch for virologic failure during first-line antiretroviral therapy in resource-limited settings.
abstract: We evaluated adult Nigerian patients with antiretroviral switch to second-line treatment with ritonavir-boosted protease inhibitor (PI/r)-based regimens due to virologic failure (confirmed HIV-1 RNA viral load [VL] >1000 copies/mL) during first-line antiretroviral therapy. Proportion of patients with VL >400 copies/mL and characteristics associated with nonsuppression during second-line treatment are described. Approximately 15% of patients (34 of 225) had VL >400 copies/mL at 1-year after treatment switch to PI/r-based regimens. In adjusted analyses, VL ≥5 log10 copies/mL at treatment switch (odds ratio [OR] 2.90 [confidence interval (CI) 1.21-6.93]); duration of first-line treatment after virologic failure >180 days (OR 2.56 [CI 1.0-6.54]); and PI/r regimen adherence <90% (OR 3.27 [CI 1.39-7.68]) were associated with VL >400 copies/mL at 1 year of second-line treatment. We therefore recommend that the maximum permissible time between suspicion of virologic failure and completion of antiretroviral treatment switch should not exceed 6 months when patients develop first-line antiretroviral failure in resource-limited settings.
authors.affiliation: Department of Family Medicine, University College Hospital, Ibadan, Nigeria. adedotun_adetunji@yahoo.com
authors.forename: Adedotun A
authors.initials: AA
authors.lastname: Adetunji
authors.forename: Chad
authors.initials: C
authors.lastname: Achenbach
authors.forename: Joseph
authors.initials: J
authors.lastname: Feinglass
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Darin
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Scarsi
authors.forename: Ernest
authors.initials: E
authors.lastname: Ekong
authors.forename: Babafemi O
authors.initials: BO
authors.lastname: Taiwo
authors.forename: Isaac F
authors.initials: IF
authors.lastname: Adewole
authors.forename: Robert
authors.initials: R
authors.lastname: Murphy
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D003906:Developing Countries; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D015999:Multivariate Analysis; D009549:Nigeria; D010044:Outpatient Clinics, Hospital; D012367:RNA, Viral / Q000097:blood; D019438:Ritonavir / Q000627:therapeutic use; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D004338:Drug Combinations; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D061466:Lopinavir; D019438:Ritonavir
keywords: ART; antiretroviral; first-line; treatment switch; virologic failure