title: Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam.
abstract: The growing numbers of HIV-infected patients requiring second-line antiretroviral therapy (ART) in Vietnam make essential the evaluation of treatment efficacy to guide treatment strategies.We evaluated all patients aged ≥15 years who initiated second-line ART after documented failure of first-line therapy at the Hospital for Tropical Diseases in Ho Chi Minh City. The primary outcome was time from second-line ART initiation to death, or to a new or reoccurrence of a WHO-defined immunological or clinical failure event, whichever occurred first. Risks of treatment failure and death were evaluated using Cox proportional hazards modeling.Data from 326 of 373 patients initiating second-line ART between November 2006 and August 2011 were included in this analysis. The median age was 32 years (IQR: 28-36). Eighty one percent were men. The median CD4 count was 44 cells/μL (IQR: 16-84). During a median follow-up of 29 months (IQR: 15-44), 60 (18.4%) patients experienced treatment failure, including 12 immunological failures, 4 WHO stage IV AIDS events, and 44 deaths (13.5%). Sixty percent of deaths occurred during the first 6-12 months. The Kaplan-Meier estimates of treatment failure after 1, 2, 3, and 4 years were 13.1% (95% CI: 9.2-16.8), 18.6% (95% CI: 14.0-23.1), 20.4% (95% CI: 15.4-25.1), and 22.8% (95% CI: 17.2-28.1), respectively. Older age, history of injection drug use, lower CD4 count, medication adherence <95%, and previous protease inhibitor use independently predicted treatment failure.While treatment efficacy was similar to that reported from other resource-limited settings, mortality was higher. Early deaths may be averted by prioritizing second-line therapy for those with lower CD4 counts and by improving treatment adherence support.
authors.affiliation: From the Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (VPT, MW, NDA, JF, JD, GT, TLE); Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (VMQ, NVVC); Hawaii Centre for AIDS, University of Hawaii at Manoa, Honolulu, Hawaii (CS, TLE); and Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia (SD).
authors.forename: Vu Phuong
authors.initials: VP
authors.lastname: Thao
authors.forename: Vo Minh
authors.initials: VM
authors.lastname: Quang
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.forename: Nguyen Duc
authors.initials: ND
authors.lastname: Anh
authors.forename: Cecilia
authors.initials: C
authors.lastname: Shikuma
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Sarah
authors.initials: S
authors.lastname: Dunstan
authors.forename: Nguyen Van Vinh
authors.initials: NVV
authors.lastname: Chau
authors.forename: Jeremy
authors.initials: J
authors.lastname: Day
authors.forename: Guy
authors.initials: G
authors.lastname: Thwaites
authors.forename: Thuy
authors.initials: T
authors.lastname: Le
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents