The use of third-line combined antiretroviral treatment and determinants of treatment outcomes among HIV/AIDS patients in Ethiopia
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Date
2023-11
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Addis Ababa University
Abstract
Background:
The treatment of human immunodeficiency virus (HIV) infection involves the use of
combination antiretroviral therapy (cART). The use of these multidrug regimens substantially
reduces the progression to AIDS, opportunistic infections, hospitalizations, and death. The
standard of care in HIV management is to maximally suppress plasma HIV RNA to prevent
HIV disease progression and the emergence of drug-resistant virus. Third-line regimens
include drugs such as newer generation NNRTIs like etravirine (ETV), boosted PIs like
ritonavir-boosted darunavir (DRV/r), as well as the integrase inhibitor like Dolutegravir
(DTG) with or without previously used ARV drugs that potentially maintained residual
antiviral activity, especially from the NRTI class.(1,2) Although there were few studies with
newer agents, cohort data showed high mortality among people for whom second-line ART
had failed. Salvage regimens were recommended with new drugs such as DRV/r, ETV and
RAL.
Objectives:
General objectives:
To describe baseline, virologic and therapeutic characteristics of PWHIV on 3rd line cART
Specific objectives
To analyse the virologic suppression in PWHIV on 3rd line cART
To describe the adherence status of PWHIV on 3rd line cART
To assess the duration of protease inhibitors’ exposure in PWHIV on 3rd line cART
To analyse medical comorbidities in PWHIV on 3rd line cART
Methods:
This is a retrospective study with longitudinal analysis among adults (≥ 18 years) attending
Tikur Anbessa Specialized Hospital, Infectious Diseases unit, ART clinic. Then, a
longitudinal analysis was conducted to determine virological suppression among patients who
was initiated on third-line therapy and for whom a follow-up viral load was determined. The
study is aimed to describe the population of patients on third-line therapy.
Results:
A total of 51 patients are on third line cART( both guideline and expert recommended
regimens). Fifty one percent (n= 26) patients are female. Majority of the respondents claimed
that they acquired the virus through unprotected sexual intercourse (66%) and 28% percent of
patents acquired the virus through vertical transmission from mother to child. Majority of
patients had WHO stage-III or stage-IV defining conditions (37.3% & 35.3% respectively).
Tenofovir Disoproxil Fumarate/Lamivudine/Efavirenz was the first line regimen in 37.3% of
patients and Tenofovir Disoproxil Fumarate, Lamivudine and Ritonavir boosted Atazanavir
was a second line cART in 39.2% patients. Dolutegravir, Lamivudine, Ritonavir boosted
Darunavir is the expert recommended third line regimen (94.1%). 76.5% (n= 39) have
undetectable viral load on third line cART. Patients transferred due to first line treatment
failure had an 11 times greater chance of having undetectable HIV RNA levels compared to
those referred due to second line treatment failure.
Conclusions:
The use of expert recommended third line cART composed of DTG, 3TC, DRV and RTV is
effective in our setting especially in PWHIV who are referred to our center after 1st line
cART treatment failure.
Description
Keywords
HIV/AIDS, Third line cART, Virologic suppression