title: Use of third line antiretroviral therapy in Latin America.
abstract: BACKGROUND
  Access to highly active antiretroviral therapy (HAART) is expanding in Latin America. Many patients require second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART, essential for program planning, is not known.
  
  
  METHODS
  Antiretroviral-naïve patients ≥18 years who started first HAART after January 1, 2000 in Caribbean, Central and South America Network (CCASAnet) sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART.
  
  
  RESULTS
  Of 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3%) failed a second line regimen and 44 (0.8%) received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18-2.00, p = 0.001), younger age (HR = 2.76 for 20 vs. 40 years, 95% CI 1.86-4.10, p<0.001), and prior AIDS (HR = 2.17, 95% CI 1.62-2.90, p<0.001).
  
  
  CONCLUSIONS
  Third line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third line regimens is warranted.
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Carina
authors.initials: C
authors.lastname: Cesar
authors.affiliation: Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.affiliation: Pan American Health Organization, Washington, D.C., United States of America.
authors.forename: Massimo
authors.initials: M
authors.lastname: Ghidinelli
authors.affiliation: Pan American Health Organization, Washington, D.C., United States of America.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Castro
authors.affiliation: Instituto de Pesquisa Clinica Evandro Chagas-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Valdiléa Gonçalves
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Universidad de Chile, Santiago, Chile.
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Cortes
authors.affiliation: Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras.
authors.forename: Denis
authors.initials: D
authors.lastname: Padgett
authors.affiliation: Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
authors.forename: Brenda
authors.initials: B
authors.lastname: Crabtree-Ramirez
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Valeria
authors.initials: V
authors.lastname: Fink
authors.affiliation: Coordinación Sida, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Adriana
authors.initials: A
authors.lastname: Duran
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.affiliation: Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D007843:Latin America; D008297:Male; D020380:Needs Assessment
chemical_list: D019380:Anti-HIV Agents