title: Profile of HIV-infected patients receiving second-line antiretroviral therapy in a resource-limited setting in Nigeria.
abstract: BACKGROUND
  Second-line antiretroviral therapy (ART) accounts for less than 5% of total ART in resource-limited settings. We described the baseline characteristics, reasons for switch and treatment outcomes of Nigerian patients receiving second-line ART.
  
  
  METHODS
  In this retrospective cohort study we recorded the baseline characteristics of HIV-infected adults whose treatment regimen was switched from a non-nucleoside reverse transcriptase inhibitor, a first-line agent, to a protease inhibitor-based second-line regimen. The duration of follow-up was 12 months.
  
  
  RESULTS
  Of 4229 patients who started first-line therapy, 186 (4.4%) were switched to second-line therapy after a mean duration of 16.6 ± 7.6 months. Their mean age was 41.8 ± 9.6 years and 59.1% were women. The median (range) viral load and CD4 cell counts at switch were 4.7 (4.1-6.3) log10 copies/ml and 71 (6-610) cells/µl, respectively. The predominant reason for switch was virological failure (79.0%). Only 55.4% and 36.6% of patients had CD4 cell count and viral load at 12 months. About 82%, 79% and 82% of patients with available data achieved virological suppression at 3 months, 6 months and 12 months respectively (p = 0.81). The proportion of patients who achieved ≥50% rise in CD4 cell count increased from 55.8% at 3 months to 78.6% at 12 months (p = 0.0002).
  
  
  CONCLUSIONS
  The rate of switch to second-line therapy was low but there were good treatment outcomes among patients with available data. Attrition rate was high. Regular viral load monitoring, improved availability/affordability of second-line regimens and retention in care should become priorities in resource-limited settings.
authors: Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
authors: Cajetan C
authors: CC
authors: Onyedum
authors: Michael O
authors: MO
authors: Iroezindu
authors: Chinwe J
authors: CJ
authors: Chukwuka
authors: Chukwujekwu E
authors: CE
authors: Anyaene
authors: Frank I
authors: FI
authors: Obi
authors: Ekenechukwu E
authors: EE
authors: Young
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors
keywords: Antiretroviral therapy; HIV; Resource-limited setting; Second-line; Treatment outcome