Use and Outcomes of Second- and Third-Line HIV Treatment in South Africa

Project Description

As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail, and eventually may need third-line treatment regimens. However, with little experience with second- and third-line treatments in resource-limited settings, it is not clear how well patients will do on these medications. As the cost of second- and third-line medications is much higher than first-line, it is critical to evaluate whether these medications can be delivered effectively as part of a large-scale public health response to HIV. To date there have been only a limited number of such evaluations, as they require large databases to conduct a robust evaluation.

To evaluate the need for and effectiveness of second- and third-line ART, we have analyzed data from several large clinical HIV treatment databases in South Africa, including the Themba Lethu Clinical HIV Cohort, the Right to Care Clinical Cohort and the IeDEA-SA cohort. Our findings show that most patients on second-line ART are alive and in care and are achieving viral load suppression in the year after being switched but that the need for both second- and third-line ART is increasing over time. These results suggest that these regimens can effectively be delivered to patients who fail first-line in such settings but they come at an increased cost compared to first-line ART. These findings represent some of the first evaluations of second and third-line ART in a resource-limited setting.

Project Details

Principal Investigator Matthew Fox
Country(ies) South Africa
Dates of Research 2008 – present