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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Mortality after failure of antiretroviral therapy in sub-Saharan Africa
Tropical Medicine and International Health, Volume 15, No. 2, Year 2010
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Description
Objective To assess the outcome of patients who experienced treatment failure with antiretrovirals in sub-Saharan Africa. Methods Analysis of 11 antiretroviral therapy (ART) programmes in sub-Saharan Africa. World Health Organization (WHO) criteria were used to define treatment failure. All ART-naive patients aged ≥16 who started with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen and had at least 6 months of follow-up were eligible. For each patient who switched to a second-line regimen, 10 matched patients who remained on a non-failing first-line regimen were selected. Time was measured from the time of switching, from the corresponding time in matched patients, or from the time of treatment failure in patients who remained on a failing regimen. Mortality was analysed using Kaplan-Meier curves and random-effects Cox models. Results Of 16 591 adult patients starting ART, 382 patients (2.3%) switched to a second-line regimen. Another 323 patients (1.9%) did not switch despite developing immunological or virological failure. Cumulative mortality at 1 year was 4.2% (95% CI 2.2-7.8%) in patients who switched to a second-line regimen and 11.7% (7.3%-18.5%) in patients who remained on a failing first-line regimen, compared to 2.2% (1.6-3.0%) in patients on a non-failing first-line regimen (P < 0.0001). Differences in mortality were not explained by nadir CD4 cell count, age or differential loss to follow up. Conclusions Many patients who meet criteria for treatment failure do not switch to a second-line regimen and die. There is an urgent need to clarify the reasons why in sub-Saharan Africa many patients remain on failing first-line ART. © 2009 Blackwell Publishing Ltd.
Authors & Co-Authors
Keiser, Olivia
Switzerland, Bern
University of Bern
Tweya, Hannock M.
Malawi, Lilongwe
Lighthouse Trust
Braitstein, Paula K.A.
United States, Indianapolis
Indiana University School of Medicine
Kenya, Eldoret
Moi University
Kenya, Eldoret
Academic Model Providing Access to Healthcare
United States, Indianapolis
Indiana University-purdue University Indianapolis
Dabis, Franćois Ç.Ois
France, Paris
Inserm
MacPhail, Andrew Patrick
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Boulle, Andrew
South Africa, Cape Town
University of Cape Town
Nash, Denis B.
United States, New York
Mailman School of Public Health
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Lüthi, Ruedi
Zimbabwe, Harare
Newlands Clinic
Brinkhof, Martin W.G.
Switzerland, Bern
University of Bern
Schechter, Mauro T.
Brazil, Rio de Janeiro
Universidade Federal do Rio de Janeiro
Egger, Matthias
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Statistics
Citations: 91
Authors: 12
Affiliations: 13
Identifiers
Doi:
10.1111/j.1365-3156.2009.02445.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Study Design
Cohort Study