A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa

Christian Rudman,Malie Rheeders,Michelle Viljoen

doi:10.4314/ahs.v20i2.2

Christian Rudman, Malie Rheeders + Show 1 more

Open Access

https://doi.org/10.4314/ahs.v20i2.2

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Abstract

Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the need for third-line ART (TLART) in a resource-limited setting. To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the North West province. All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult patient health records (2002-2017) and analysed. 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years (39.5-47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was 101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269 (765-2 343); 1 512 (706-2096) and 71 (58-126) days respectively.High-level resistance most prevalent were: nelfinavir/r (85.7%), indinavir/r (80.9%), lopinavir/r (76.2%), emtricitabine and lamivudine (95.2%), nevirapine (76.2%) and efavirenz (71.4%). Resistance to 3 major PI mutations in 95% of patients and cross resistance were documented extensively. This study support the need for earlier resistance testing. It firstly reported on time duration post diagnosis on various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts.

Highlights

Human immunodeficiency virus (HIV) infection remains a global pandemic, with an estimated 36.7 million people living with HIV globally at the end of 20161,2
UNAIDS set out the ambitious 90-90-90 targets to be reached by end of 2020, where 90% of people living with HIV should be diagnosed, 90% of the people diagnosed with HIV should receive antiretroviral therapy (ART) and 90% of those receiving ART should
Inclusion criteria for this study were all adult patients (≥ 18 years) approved and already initiated on third-line ART (TLART) by the end of April 2017. These adult patients should have been on a presented in Tables 2 (PIs)-based second-line ART regimen for at least 12 months, with confirmed boosted PI resistance by means of a genotypic antiretroviral resistance testing (GART) performed by the National Health Laboratory Service (NHLS) of South Africa, before TLART could be initiated

Summary

Introduction

Human immunodeficiency virus (HIV) infection remains a global pandemic, with an estimated 36.7 million people living with HIV globally at the end of 20161,2. It is paramount to effectively optimise patient management and care through rigorous policies and guidelines, especially in a resource-limited setting like South Africa The aim of this investigation was to describe and report on the clinical characteristics and HIV resistance patterns of all adult patients who were initiated on TLART in three districts of the North West Province in South Africa during the time of this investigation. Conclusion: This study support the need for earlier resistance testing It firstly reported on time duration post diagnosis on various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts. A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa.

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