Immunological failure of first-line and switch to second-line antiretroviral therapy among HIV-infected persons in Tanzania: analysis of routinely collected national data

Tropical Medicine & International Health : TM & IH
Fiona M VanobberghenJim Todd

Abstract

Rates of first-line treatment failure and switches to second-line therapy are key indicators for national HIV programmes. We assessed immunological treatment failure defined by WHO criteria in the Tanzanian national HIV programme. We included adults initiating first-line therapy in 2004-2011 with a pre-treatment CD4 count, and ≥6-months of follow-up. We assessed subhazard ratios (SHR) for immunological treatment failure, and subsequent switch to second-line therapy, using competing risks methods to account for deaths. Of 121 308 adults, 7% experienced immunological treatment failure, and 2% died without observed immunological treatment failure, over a median 1.7 years. The 6-year cumulative probability of immunological treatment failure was 19.0% (95% CI 18.5, 19.7) and of death, 5.1% (4.8, 5.4). Immunological treatment failure predictors included earlier year of treatment initiation (P < 0.001), initiation in lower level facilities (SHR = 2.23 [2.03, 2.45] for dispensaries vs. hospitals), being male (1.27 [1.19, 1.33]) and initiation at low or high CD4 counts (for example, 1.78 [1.65, 1.92] and 5.33 [4.65, 6.10] for <50 and ≥500 vs. 200-349 cells/mm(3) , respectively). Of 7382 participants in the time-to-switch analysis, 6% sw...Continue Reading

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Citations

Apr 8, 2017·The Journal of Antimicrobial Chemotherapy·Claudia HawkinsWafaie Fawzi
Mar 1, 2017·European Journal of Hospital Pharmacy. Science and Practice·Carmen Sobrino-JiménezAlicia Herrero-Ambrosio
Oct 17, 2020·HIV/AIDS : Research and Palliative Care·Teklehaimanot Fentie Wendie, Birhanu Demeke Workneh

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