Virologic outcome among HIV-1 infected adults on second-line antiretroviral therapy in Jos, Nigeria

Abstract

More people living with HIV are now accessing free antiretroviral therapy (ART) through public health programmes in resource-limited settings. Currently, third-line (3L) ART for patients failing second-line (2L) ART in most of these programmes is not readily available. Yet, data on effectiveness of 2LART are limited. To adequately address and prepare for the need for 3L, critical assessments of the outcomes of second-line ART are needed. This was a retrospective cohort study of patients accessing 2L ART at the Jos University Teaching Hospital (JUTH), Jos adult HIV clinic from 2004 to 2018. We determined the proportion of patients failing 2L ART, evaluated time to virologic failure, time to lost to follow up and time to death using Kaplan-Meier estimates. Virologic failure (VF) was defined as 2 consecutive viral load result >1000copies/ml when the patient had been on ART for at least 6 months and undetectable viral load as < 400 copies/ml. A total of 285 patients were included in the study, with a mean age of 45±9.5 years. Females were 194 (68.1%). All patients were on boosted protease inhibitor, the predominant ART for use as 2L regimen was Lopinavir boosted with ritonavir in combination with Tenofovir, Lamivudine and Zidovudine (43.9%). The baseline median viral load was 54481 (IQR 6950-161640) copies/ml. The proportion of patients with virologic failure was 33(11.6%) at 48 weeks. The proportion of patients with detectable viral load was 66.0%, 30.2%, 30.5% and 27.9% at 12weeks, 24weeks, 48weeks and 72 weeks, respectively. The mean time to virologic failure, loss to follow up and death on second-line ART was 7.473± 0.269 (CI 6.946-8.000) years, 7.228±0.250 (CI 6.783-7.717) years, and 9.697±0.091 (CI 9.519-9.874) years respectively. In conclusion, 2L ART virologic failure rates in our cohort are comparatively low to other LMIC but fall short of target 95-95-95.