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 preventHIV disease progression and the emergence of drug-resistant virus. Third-line regimensinclude 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 ARThad failed. Salvage regimens were recommended with new drugs such as DRV/r, ETV andRAL.
Objectives:General objectives:To describe baseline, virologic and therapeutic characteristics of PWHIV on 3rd line cART Specific objectivesTo analyse the virologic suppression in PWHIV on 3rd line cARTTo describe the adherence status of PWHIV on 3rd line cARTTo assess the duration of protease inhibitors’ exposure in PWHIV on 3rd line cARTTo analyse medical comorbidities in PWHIV on 3rd line cART
Methods:This is a retrospective study with longitudinal analysis among adults (≥ 18 years) attendingTikur Anbessa Specialized Hospital, Infectious Diseases unit, ART clinic. Then, alongitudinal 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. Thestudy 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 recommendedregimens). Fifty one percent (n= 26) patients are female. Majority of the respondents claimedthat they acquired the virus through unprotected sexual intercourse (66%) and 28% percent ofpatents acquired the virus through vertical transmission from mother to child. Majority ofpatients 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% ofpatients and Tenofovir Disoproxil Fumarate, Lamivudine and Ritonavir boosted Atazanavirwas a second line cART in 39.2% patients. Dolutegravir, Lamivudine, Ritonavir boostedDarunavir is the expert recommended thirdlineregimen (94.1%). 76.5% (n= 3haveundetectable viral load on third line cART. Patients transferred due to first line treatmentfailure had an 11 times greater chance of having undetectable HIV RNA levels compared tothose referred due to second line treatment failure.
Conclusions:The use of expert recommended third line cART composed of DTG, 3TC, DRV and RTV iseffective in our setting especially in PWHIV who are referred to our center after 1st linecART treatment failure.
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Keywords
HIV/AIDS, Third line cART, Virologic suppression