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Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam

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...

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Autores principales: Thao, Vu Phuong, Quang, Vo Minh, Wolbers, Marcel, Anh, Nguyen Duc, Shikuma, Cecilia, Farrar, Jeremy, Dunstan, Sarah, Chau, Nguyen Van Vinh, Day, Jeremy, Thwaites, Guy, Le, Thuy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985375/
https://www.ncbi.nlm.nih.gov/pubmed/26512561
http://dx.doi.org/10.1097/MD.0000000000001715
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author Thao, Vu Phuong
Quang, Vo Minh
Wolbers, Marcel
Anh, Nguyen Duc
Shikuma, Cecilia
Farrar, Jeremy
Dunstan, Sarah
Chau, Nguyen Van Vinh
Day, Jeremy
Thwaites, Guy
Le, Thuy
author_facet Thao, Vu Phuong
Quang, Vo Minh
Wolbers, Marcel
Anh, Nguyen Duc
Shikuma, Cecilia
Farrar, Jeremy
Dunstan, Sarah
Chau, Nguyen Van Vinh
Day, Jeremy
Thwaites, Guy
Le, Thuy
author_sort Thao, Vu Phuong
collection PubMed
description 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.
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spelling pubmed-49853752016-08-26 Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam Thao, Vu Phuong Quang, Vo Minh Wolbers, Marcel Anh, Nguyen Duc Shikuma, Cecilia Farrar, Jeremy Dunstan, Sarah Chau, Nguyen Van Vinh Day, Jeremy Thwaites, Guy Le, Thuy Medicine (Baltimore) 4850 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. Wolters Kluwer Health 2015-10-30 /pmc/articles/PMC4985375/ /pubmed/26512561 http://dx.doi.org/10.1097/MD.0000000000001715 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4850
Thao, Vu Phuong
Quang, Vo Minh
Wolbers, Marcel
Anh, Nguyen Duc
Shikuma, Cecilia
Farrar, Jeremy
Dunstan, Sarah
Chau, Nguyen Van Vinh
Day, Jeremy
Thwaites, Guy
Le, Thuy
Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title_full Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title_fullStr Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title_full_unstemmed Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title_short Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam
title_sort second-line hiv therapy outcomes and determinants of mortality at the largest hiv referral center in southern vietnam
topic 4850
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985375/
https://www.ncbi.nlm.nih.gov/pubmed/26512561
http://dx.doi.org/10.1097/MD.0000000000001715
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