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Home >> Publications >> Use of third line antiretroviral therapy in Latin America.

Publication

Author(s):

Cesar C, Shepherd BE, Jenkins CA, Ghidinelli M, Castro JL, Veloso VG, Cortes CP, Padgett D, Crabtree-Ramirez B, Gotuzzo E, Fink V, Duran A, Sued O, McGowan CC, Cahn P; Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).

Pub Title:

Use of third line antiretroviral therapy in Latin America.

Pub Date:

Sep 15 2014

Journal:

Title: 
PLoS One
Link: 
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0106887

PubMed: 25221931
Pub PDF: PDF icon 25221931.pdf

Abstract
BACKGROUND:
Access to highly active antiretroviral therapy (HAART) is expanding in Latin America. Many patients require second and third line therapy due to toxicity, tolerability, failure, or a combination of factors. The need for third line HAART, essential for program planning, is not known.

METHODS: Antiretroviral-naïve patients ≥18 years who started first HAART after January 1, 2000 in Caribbean, Central and South America Network (CCASAnet) sites in Argentina, Brazil, Honduras, Mexico, and Peru were included. Clinical trials participants were excluded. Third line HAART was defined as use of darunavir, tipranavir, etravirine, enfuvirtide, maraviroc or raltegravir. Need for third line HAART was defined as virologic failure while on second line HAART.

RESULTS: Of 5853 HAART initiators followed for a median of 3.5 years, 310 (5.3%) failed a second line regimen and 44 (0.8%) received a third line regimen. Cumulative incidence of failing a 2nd or starting a 3rd line regimen was 2.7% and 6.0% three and five years after HAART initiation, respectively. Predictors at HAART initiation for failing a second or starting a third line included female sex (hazard ratio [HR] = 1.54, 95% confidence interval [CI] 1.18-2.00, p = 0.001), younger age (HR = 2.76 for 20 vs. 40 years, 95% CI 1.86-4.10, p<0.001), and prior AIDS (HR = 2.17, 95% CI 1.62-2.90, p<0.001).

CONCLUSIONS: Third line regimens may be needed for at least 6% of patients in Latin America within 5 years of starting HAART, a substantial proportion given the large numbers of patients on HAART in the region. Improved accessibility to third line regimens is warranted.

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Citation:

Cesar C, Shepherd BE, Jenkins CA, Ghidinelli M, Castro JL, Veloso VG, Cortes CP, Padgett D, Crabtree-Ramirez B, Gotuzzo E, Fink V, Duran A, Sued O, McGowan CC, Cahn P; Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet). Use of third line antiretroviral therapy in Latin America. PLoS One. 2014 Sep 15;9(9):e106887. doi: 10.1371/journal.pone.0106887. eCollection 2014. PubMed PMID: 25221931; PubMed Central PMCID: PMC4164470.