Use and Outcomes of Second-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. However, with little experience with second-line treatments in resource-limited settings, it is not clear how well patients will do on these medications if their first regimen fails. As the cost of second-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 how well patients did on second-line ART, we reviewed the records of all patients who switched to standard second-line therapy after failure of first-line therapy at South Africa’s Themba Lethu Clinic. Of approximately 10,000 patients started on first-line, we identified 328 patients subsequently initiated on second-line. To evaluate the effectiveness of these medications, we sought to determine whether these patients were still alive and in care, were virologically suppressed, and had any increase in CD4 count in the year after they started second-line medications.

Our findings show that patients on second-line ART are alive and in care and are achieving viral load suppression in the year after being switched. These results suggest that second-line can effectively be delivered to patients who fail first-line in such settings. These findings represent one of the first evaluations of second-line ART in a resource-limited setting.

This project is one activity of the CGHD’s Economics and Epidemiology of HIV/AIDS Care and Treatment (South Africa Associate Award).

Project Details

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