Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis.

Dumessa Edessa,Fekede Asefa,Mekonnen Sisay,Jason Blackard

doi:10.1371/journal.pone.0220159

Dumessa Edessa, Fekede Asefa + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0220159

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Journal: PloS one	Publication Date: Jul 29, 2019
Citations: 40	License type: CC BY 4.0

Affiliation: Haramaya University, University of Technology Sydney

Abstract

BackgroundIncreased second-line antiretroviral therapy (ART) failure rate narrows future options for HIV/AIDS treatment. It has critical implications in resource-limited settings; including sub-Saharan Africa (SSA) where the burden of HIV-infection is immense. Hence, pooled estimate for second-line HIV treatment failure is relevant to suggest valid recommendations that optimize ART outcomes in SSA.MethodsWe retrieved literature systematically from PUBMED/MEDLINE, EMBASE, CINAHL, Google Scholar, and AJOL. The retrieved studies were screened and assessed for eligibility. We also assessed the eligible studies for their methodological quality using the Joanna Briggs Institute’s appraisal checklist. The pooled estimates for second-line HIV treatment failure and its associated factors were determined using STATA, version 15.0 and MEDCALC, version 18.11.3, respectively. We assessed publication bias using Comprehensive Meta-analysis software, version 3. Detailed study protocol for this review/meta-analysis is registered and found on PROSPERO (ID: CRD42018118959).ResultsA total of 33 studies with the overall 18,550 participants and 19,988.45 person-years (PYs) of follow-up were included in the review. The pooled second-line HIV treatment failure rate was 15.0 per 100 PYs (95% CI: 13.0–18.0). It was slightly higher at 12–18 months of follow-up (19.0/100 PYs; 95% CI: 15.0–22.0), in children (19.0/100 PYs; 95% CI: 14.0–23.0) and in southern SSA (18.0/100 PYs; 95% CI: 14.0–23.0). Baseline values (high viral load (OR: 5.67; 95% CI: 13.40–9.45); advanced clinical stage (OR: 3.27; 95% CI: 2.07–5.19); and low CD4 counts (OR: 2.80; 95% CI: 1.83–4.29)) and suboptimal adherence to therapy (OR: 1.92; 95% CI: 1.28–2.86) were the factors associated with increased failure rates.ConclusionSecond-line HIV treatment failure has become highly prevalent in SSA with alarming rates during the 12–18 month period of treatment start; in children; and southern SSA. Therefore, the second-line HIV treatment approach in SSA should critically consider excellent adherence to therapy, aggressive viral load suppression, and rapid immune recovery.

Highlights

In the past decade, rapid scale-up of antiretroviral therapy (ART) in sub-Saharan Africa (SSA) substantially reduced Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)-related morbidity and mortality [1, 2]
A total of 33 studies with the overall 18,550 participants and 19,988.45 person-years (PYs) of follow-up were included in the review
The pooled second-line HIV treatment failure rate was 15.0 per 100 PYs

Summary

Introduction

Rapid scale-up of antiretroviral therapy (ART) in sub-Saharan Africa (SSA) substantially reduced HIV/AIDS-related morbidity and mortality [1, 2] It has prolonged the average life expectancy of HIV-infected individuals [1]. VL testing is efficient to indicate direct plasma effects of ART on HIV ribonucleic acid (RNA) [12] It helps preserve the limited HIV treatment options available by reducing the probability of incorrect switching to the more expensive and toxic regimens [13]. Increased second-line antiretroviral therapy (ART) failure rate narrows future options for HIV/AIDS treatment It has critical implications in resource-limited settings; including subSaharan Africa (SSA) where the burden of HIV-infection is immense. Pooled estimate for second-line HIV treatment failure is relevant to suggest valid recommendations that optimize ART outcomes in SSA.

Methods

Results

Conclusion