학술논문
Use of third line antiretroviral therapy in Latin America.
Document Type
article
Author
Carina Cesar; Bryan E Shepherd; Cathy A Jenkins; Massimo Ghidinelli; Jose Luis Castro; Valdiléa Gonçalves Veloso; Claudia P Cortes; Denis Padgett; Brenda Crabtree-Ramirez; Eduardo Gotuzzo; Valeria Fink; Adriana Duran; Omar Sued; Catherine C McGowan; Pedro Cahn; Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet)
Source
PLoS ONE, Vol 9, Iss 9, p e106887 (2014)
Subject
Language
English
ISSN
1932-6203
Abstract
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.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.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