title: Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: results from the TREAT Asia HIV observational database.
abstract: BACKGROUND
  Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources, it is important to optimize the timing of second-line ART initiation and use the most effective compounds available.
  
  
  METHODS
  HIV-positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated.
  
  
  RESULTS
  There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells per cubic millimeter, and median HIV viral load was 16,224 copies per milliliter. Patients started second-line ART before 2007 (n = 105), 2007-2010 (n = 147) and after 2010 (n = 50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line therapy was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95% confidence interval: 7.1 to 10.9) and 1.1 (95% confidence interval: 0.6 to 1.9), respectively. Older age, high baseline viral load, and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure.
  
  
  CONCLUSIONS
  Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.
authors.affiliation: *Biostatistics and Databases Program, The Kirby Institute, UNSW Australia, Sydney, Australia; †National Hospital of Tropical Diseases, Hanoi, Vietnam; ‡TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand; §Infectious Diseases Unit, Department of Medicine, Hospital Sungai Buloh, Sungai Buloh, Malaysia; ‖Faculty of Medicine, Infectious Diseases Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; and ¶HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: David C
authors.initials: DC
authors.lastname: Boettiger
authors.forename: Van K
authors.initials: VK
authors.lastname: Nguyen
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Huy V
authors.initials: HV
authors.lastname: Bui
authors.forename: Benedict L
authors.initials: BL
authors.lastname: Heng Sim
authors.forename: Iskandar
authors.initials: I
authors.lastname: Azwa
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001208:Asia; D000069446:Atazanavir Sulfate; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use; D016019:Survival Analysis; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D009842:Oligopeptides; D011725:Pyridines; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir