Outcome of Patients on Second Line of Antiretroviral Therapy in Dakar
In resource-limited countries, late start of antiretroviral treatment, lack of compliance and limited access to viral load testing are all factors that contribute to the increase in the number of second-line patients. Despite this situation, treatment options remain limited in our countries. The objectives of this study were to describe the characteristics of patients and to evaluate the outcome of HIV-1 infected patients undergoing second-line ARV treatment.
According to projections, the number of people on second-line of antiretroviral treatment (ART) is expected to increase by 2030 to 0.8-4.6 million (6.6-19.6%) in sub-Saharan Africa. Therapeutic Non-compliance is one of the main reasons for the emergence of resistant viruses. In Africa, several factors influence compliance to antiretroviral treatment: adverse socio-economic conditions, stock outs, drug toxicities, co-morbidities and stigmatization. A suboptimal compliance level of less than 90% is the cause of therapeutic failure defined in resource-limited countries by "a detectable viral load higher than 1000 copies/ml persistently after at least six months of taking ARV". Viral load measurement is the gold standard for monitoring the effectiveness of ARV treatment and diagnosing therapeutic failure. However, in resource-limited countries, for a long time the change of treatment was based on the occurrence of opportunistic infections and/or a decrease in the rate of TCD4+ lymphocytes. These results in delayed treatment change associated with the accumulation of resistance mutations with cross-resistance to other molecules that may compromise the efficacy of subsequent therapeutic options.
Overall, we observed that changes in treatment occurred late and a high rate of lost to follow-up patients was noticed. In order to remedy this situation, it is necessary to make the viral load measurement available by nationwide implementation of the quantitative point-of care (POC) HIV viral load assay and an alert system with the social service so as to reduce the rate of treatment interruption. The evaluation of the efficacy, safety and outcome of second-line antiretroviral treatment patients by analysing our different cohorts are necessary to better orient our treatment access policies.
Journal of Infectious Diseases & Therapy
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