Treatment outcomes of over 1000 patients on second-line, protease inhibitor-based antiretroviral therapy from four public-sector HIV treatment facilities across Johannesburg, South Africa

Objectives To report predictors of outcomes of second-line ART for HIV treatment in resource-limited settings. Methods All adult ART-naive patients who initiated standard first-line treatment between April 2004-February 2012 at four public-sector health facilities in Johannesburg, South Africa, experienced virologic failure, and initiated standard second-line therapy were included. We assessed predictors of attrition (death and loss to follow-up [≥3 months late for a scheduled visit]) using Cox proportional hazards regression and predictors of virologic suppression (viral load <400 copies/ml ≥3 months after switch) using modified Poisson regression with robust error estimation at one year and ever after second-line ART initiation. Results 1,236 patients switched to second-line a median (IQR) of 1.9 (0.9-4.6) months after first-line virologic failure. 12.6% and 45.3% of patients were no longer in care at one-year and at the end of follow-up, respectively. Patients with low CD4 counts (<50 vs. ≥200, aHR: 1.85; 95% CI: 1.03-3.32) at second-line switch were at greater risk for attrition by the end of follow-up. 74.9% of patients suppressed by one-year and 85.3% had ever suppressed by the end of follow-up. Conclusions Patients with poor immune status at switch to second-line ART were at greater risk of attrition and were less likely to suppress. Additional adherence support after switch may improve outcomes. This article is protected by copyright. All rights reserved.