Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

ABSTRACT Background: Myanmar has a high burden of Human Immunodeficiency Virus (HIV) and second-line antiretroviral treatment (ART) has been available since 2008 in the public health sector. However, there have been no published data about the outcomes of such patients until now. Objective: To assess the treatment and programmatic outcomes and factors associated with unfavorable outcomes (treatment failure, death and loss to follow-up from care) among people living with HIV (aged ≥ 10 years) receiving protease inhibitor-based second-line ART under the Integrated HIV Care Program in Myanmar between October 2008 and June 2015. Design: Retrospective cohort study using routinely collected program data. Results: Of 824 adults and adolescents on second-line ART, 52 patients received viral load testing and 19 patients were diagnosed with virological failure. However, their treatment was not modified. At the end of a total follow-up duration of 7 years, 88 (11%) patients died, 35 (4%) were lost to follow-up, 21 (2%) were transferred out to other health facilities and 680 (83%) were still under care. The incidence rate of unfavorable outcomes was 7.9 patients per 100 person years follow-up. Patients with a history of injecting drug use, with a history of lost to follow-up, with a higher baseline viral load and who had received didanosine and abacavir had a higher risk of unfavorable outcomes. Patients with higher baseline C4 counts, those having taken first-line ART at a private clinic, receiving ART at decentralized sites and taking zidovudine and lamivudine had a lower risk of unfavorable outcomes. Conclusions: Long-term outcomes of patients on second-line ART were relatively good in this cohort. Virological failure was relatively low, possibly because of lack of viral load testing. No patient who failed on second-line ART was switched to third-line treatment. The National HIV/AIDS Program should consider making routine viral load monitoring and third-line ART drugs available after a careful cost–benefit analysis.

[1]  J. Bartlett,et al.  The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections Among Patients Infected With Human Immunodeficiency Virus in Northern Tanzania , 2016, Open forum infectious diseases.

[2]  J. Farrar,et al.  High prevalence of PI resistance in patients failing second-line ART in Vietnam , 2015, The Journal of antimicrobial chemotherapy.

[3]  S. Sundar,et al.  Outcome of patients on second line antiretroviral therapy under programmatic condition in India , 2015, BMC Infectious Diseases.

[4]  J. Farrar,et al.  Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam , 2015, Medicine.

[5]  H. Xing,et al.  HIV virological failure and drug resistance among injecting drug users receiving first-line ART in China , 2014, BMJ Open.

[6]  C. Yiannoutsos,et al.  Delayed switch of antiretroviral therapy after virologic failure associated with elevated mortality among HIV-infected adults in Africa , 2014, AIDS.

[7]  P. Isaakidis,et al.  Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India , 2014, Global health action.

[8]  B. Ledergerber,et al.  Difference in factors associated with low-level viraemia and virological failure: results from the Austrian HIV Cohort Study , 2014, Journal of the International AIDS Society.

[9]  J. Nachega,et al.  Emergence of HIV drug resistance during first- and second-line antiretroviral therapy in resource-limited settings. , 2013, The Journal of infectious diseases.

[10]  A. Sohn,et al.  The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV-infected adolescents , 2013, Journal of the International AIDS Society.

[11]  L. Fairlie,et al.  Antiretroviral treatment, management challenges and outcomes in perinatally HIV-infected adolescents , 2013, Journal of the International AIDS Society.

[12]  N. Ford,et al.  Antiretroviral Therapy Outcomes among Adolescents and Youth in Rural Zimbabwe , 2012, PloS one.

[13]  V. Mulenga,et al.  The needs for HIV treatment and care of children, adolescents, pregnant women and older people in low-income and middle-income countries , 2012, AIDS.

[14]  N. Ford,et al.  Treatment outcomes of patients on second-line antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis , 2012, AIDS.

[15]  K. Freedberg,et al.  Virologic Failure of Protease Inhibitor-Based Second-Line Antiretroviral Therapy without Resistance in a Large HIV Treatment Program in South Africa , 2012, PloS one.

[16]  J. Eron,et al.  Second‐line treatment in the Malawi antiretroviral programme: high early mortality, but good outcomes in survivors, despite extensive drug resistance at baseline * , 2010, HIV medicine.

[17]  S. Reid,et al.  Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives. , 2010, The Lancet. Infectious diseases.

[18]  S. Strathdee,et al.  Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. , 2008, Addiction.

[19]  A. Calmy,et al.  Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières , 2008, AIDS.

[20]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[21]  Richard D Moore,et al.  Detrimental Effects of Continued Illicit Drug Use on the Treatment of HIV‐1 Infection , 2001, Journal of acquired immune deficiency syndromes.