Abstract
IntroductionFailure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M.MethodsWe conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomesfailure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure.ResultsOf the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001.ConclusionMales and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors.
Highlights
Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise
Human Immunodeficiency Virus (HIV)/Acquired immunodeficiency syndrome (AIDS) response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART
This study provides the first body of evidence to understand the factors associated with VF-M in the context of developing Uganda
Summary
Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. Antiretroviral therapy (ART) remains the only scalable biomedical intervention for reducing the impact and effect of HIV/AIDS in Sub Saharan Africa, which disproportionately carries 70% of the global HIV burden [1]. Second‐line antiretroviral therapy In sub-Saharan Africa, the proportion of HIV positive patients on second-line ART is between 1–5% [5,6,7] and is expected to rise to 0·5–3·0 and 0.8–4.6 million people between 2020 and 2030 [8]. The rising number of patients on second-line ART reduces the availability of alternative treatment options in developing countries whose health systems are still dependent on foreign aid to provide ART [10, 11]. Failure on second-line ART (having two subsequent viral counts of or greater than 1000 copies/ ml, done at least 3–6 months apart) means that care providers have to switch such patients to third-line ART [9] which is has a higher pill burden and toxicity [14]
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