TITLE:
Incidence and Factors Associated with the Switch to the Second Line Antiretroviral Treatment at the Ambulatory Treatment Center (CTA) in Dakar
AUTHORS:
Ndeye Fatou Ngom-Gueye, Gilbert Batista, Abdoul Aziz Ndiaye, Assane Diouf, KA. Daye, Alioune Badara Tall, Awa Diouf, Kine Ndiaye, Makhtar Ndiaga Diop, Mountaga Dia, Cheikh Tacko Diop, Awa Gaye, Cheikh Tidiane Ndour, Moussa Seydi, Lamine Gueye, Bernard Marcel Diop, Papa Salif Sow
KEYWORDS:
Incidence, Associated Factors, Switch to 2nd Line cART, CTA, Dakar
JOURNAL NAME:
Health,
Vol.8 No.14,
November
23,
2016
ABSTRACT: Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts 3 were included in this study. Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age 3. Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age 3 and high viral load at treatment initiation.