14th Conference on Retroviruses and Opportunistic Infections Los Angeles, California - February 25-28, 2007

Conf Retrovir Opportunistic Infect 2007 Feb 25-28;14: (abstract no. 35)

M Pujades¹, Alexandra Calmy², D O'Brien³, P Humblet⁴, and MSF HIV/AIDS working group
¹Epicentre, Paris, France; ²St Vincent's Hosp, Sydney, Australia; ³Médecins Sans Frontières, Amsterdam, The Netherlands; and ⁴Médecins sans Frontières, Brussels, Belgium

BACKGROUND: With increasing access to, and time on, ART in resource-limited countries, more people will develop failure to first-line ART. However, the lack of virological monitoring may delay detection of failure, and, in addition, the lack of alternative drugs means that second-line ART regimens are often suboptimal. Thus, outcomes on second-line ART may be adversely affected, but data on this are limited.

METHODS: We used routinely collected patient data (FUCHIA software) from 50 Médecins Sans Frontières (MSF) -supported ART projects in 22 resource-limited countries in Africa, Asia, and Central America. All adults started on second-line ART regimens were included in the analysis.

RESULTS: Globally, 253 (0.4%) of 57,147 adults who commenced ART in MSF-supported programs since 2001 have had to switch to second-line ART because of treatment failure. Of these, at first-line ART initiation, 220 (87%) were WHO clinical stage 3 or 4, and the median CD4 count was 63 cells/mL (IQR 20 to 132; n = 199); 70 (28%) were ART-experienced and 231 (91%) started standard WHO first-line therapy (55% stavudine [d4T] + lamivudine [3TC] + nevirapine [NVP]). Median time from ART initiation to switch was 15.6 months (IQR 11.7 to 22.3); 177 (70%) switched after >24 months. Median CD4 cell count at switch was 84 cells/mL (IQR 33 to 172; n = 165) with 36% < 50 and 56% < 100 cells/mL. Second-line ART regimens were nelfinavir (NFV) -based for 130 (51%) and lopinavir/ritonavir (LPV/r) -based for 99 (39%). Median follow-up on second-line ART was 11 months (IQR 5 to 18 months). Median CD4 count and CD4 gain were 169 cells/mL (IQR 100 to 301; n = 64) and 91 (47 to 151; n = 43) at 6 months, and 214 (133 to 300; n = 53) and 113 (33 to 227; n = 35) at 12 months. After a median time of 6.4 months (IQR 3.2 to 11.9), 19 (8%) patients died; and after a median time of 5.0 months (IQR 3.1 to 12.4), 16 (6%) were lost to follow-up. Probabilities of survival (endpoint deaths + lost to follow-up) at 6 and 12 months were 0.92 (IQR 0.88 to 0.95) and 0.87 (0.82 to 0.91), respectively.

CONCLUSIONS: Adult patients on ART in MSF-supported programs in resource-limited countries have infrequently required change to second-line regimens. Early outcomes for adults on protease inhibitor (PI) -based second-line ART regimens appear to be satisfactory.

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2007-02-25
35

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