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Switching to Second-Line ART Infrequent in MSF's HIV Programs

Few of the more than 48,000 patients being treated for HIV in Medecins San Frontieres (MSF) programs in resource-limited settings have required changing to second-line antiretroviral (ART) therapy, according to French and Swiss researchers.

As lead investigator Dr. Mar Pujades-Rodriguez told Reuters Health, "We found relatively low rates of switch to second-line therapy in the MSF cohorts. Switches were performed after a median of 20 months on antiretroviral therapy, and clinical and immunological early outcomes on World Health Organization recommended second-line regimens were good."

In the July 11th issue of AIDS, Dr. Pujades-Rodriguez of Epicentre, Paris and colleagues note that they examined data from 62 MSF programs and found that only 370 of 48,338 adult patients were switched to second-line ART. This amounted to a rate of 4.8/1000 person-years.

Some 51% of those who did switch were given a lopinavir/ritonavir-based regimen and 43% received a nelfinavir-based regimen. Overall, 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two.

Death rates were higher in patients in WHO stage 4 at ART initiation and in those whose CD4 nadir count was below 50 cells/microliter.

However, continued Dr. Pujades-Rodriguez, "86% remained alive and in care one year after the change in treatment. The fact that the risk of mortality was higher in the patients most severely immunosuppressed, stresses the importance of scaling up earlier access to HIV testing and treatment in resource-limited settings."

"Furthermore," the researcher concluded, "good reported outcomes on second-line therapy call for efforts to improve and make accessible diagnostic tools adapted to the field to ensure the early diagnosis of first-line treatment failure."

AIDS 2008;22:1305-1312.