Resumo

GUMEDE, S B; FISCHER, A; VENTER, W D F  e  LALLA-EDWARD, S T. Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis. SAMJ, S. Afr. med. j. [online]. 2019, vol.109, n.12, pp.919-926. ISSN 2078-5135.  http://dx.doi.org/10.7196/samj.2019.v109i12.13895.

BACKGROUND. World Health Organization guidelines recommend that HIV patients who do not achieve viral suppression on efavirenz-based first-line antiretroviral therapy (ART) should be changed to a protease inhibitor (Pl)-based regimen. In South Africa (SA), -200 000 people are on second-line treatment, but little is known about these patients.OBJECTIVES. To describe second-line black African patients in a large urban area.METHODS. A quantitative retrospective study of 825 second-line patients in central Johannesburg, SA (subdistrict F), was performed with data extracted from government databases. Demographic characteristics, treatment status and laboratory information were gathered, then analysed with CD4+ cell count, viral load (VL) and retention-in-care data as outcome variables.RESULTS. The average recorded time to VL measurement after the switch to a Pi-based ART regimen was 20 months, and 83.1% (570/686) of patients with a recent VL achieved viral suppression while on second-line treatment. The most recent median CD4+ cell count for the cohort was 286 cells/uL (interquartile range 160 - 478), which represented a 177 cells/uL increase from the baseline count at the start of first-line ART. Slightly less than three-quarters (72.4%) of the population remained active in care in the study clinics from initiation on first-line ART. Demographic characteristics such as being <25 years of age, male sex and geographical transfer (started initial treatment in a different region) independently predicted low CD4+ cell counts and virological failure on second-line treatment. Patients with virological failure were most likely (odds ratio (OR) 3.13, 95% confidence interval (CI) 1.50 - 6.56) to be lost to follow-up after the switch, while patients from Hillbrow Community Health Centre (OR 0.27, 95% CI 0.16 - 0.44), South Rand Hospital (OR 0.24, 95% CI 0.12 - 0.47) and Jeppe Clinic (OR 0.38, 95% CI 0.16 - 0.88), three larger sites, were most likely to remain active in care.CONCLUSIONS. VL suppression was high in patients on second-line treatment, but one-fifth of patients were lost to follow-up. Younger age, male sex and transfer from other treatment sites predicted poor treatment outcomes, highlighting opportunities for prioritisation of adherence interventions.

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