Abstract

Context: 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.

Methods: Retrospective cohort study conducted at the Department of Infectious and Tropical Diseases (SMIT) of the National University Hospital Centre (CHNU) of Fann in Dakar. HIV-1 infected patients on second-line ARV treatment between January 1, 2008 and December 31, 2016 were included. The data was collected from the medical records and analysed with the Info version 7 software.

Results: In our study, we included 135 patients. The median time to switch from the first to the second line of antiretroviral treatment was 3 years [2.5-5.5]. The average age was 41.7 ± 10.4 years at the start of the second ARV treatment line. The sex ratio (F/H) was 1.4. At the start of ART, 107 (79.3%) were classified as WHO stage 3 and 4 whereas this proportion was 21.5% at the time of the change of treatment. Including the second line, the median CD4+ T cell count was 122/mm³ (48-223) and after 12 months of treatment, the increase in CD4+ count was on average 208 cells/mm³. When switching to a different antiretroviral treatment, viral load was available in one third of the cases (31.8%) and the median rate was 79 900[17773-21000000] copies/ml. The most commonly used second line protocols were TDF+3TC+LPV/r (35.6%) followed by ABC+DDI+LPV/r (18.5%). Regarding the patients ’ outcomes, 13 (9.6%) died and the rate of patients lost to follow-up was 23% after a median follow-up time of 3 years (1-4.5). The median duration of second-line follow-up was 4 years (1.5-6).

Conclusion: Upon initiation of the second-line, few patients had clinical failure. However, the change in treatment remains late because the CD4+ rate was low. Treatment progress is satisfactory on average due to the high rate of lost to follow-up patients. Active research of patients should be strengthened in order to improve the second-line patient monitoring.

Keywords: Second line; Antiretroviral; Therapy; Dakar