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. 2012 Sep 1;61(1):41-8.
doi: 10.1097/QAI.0b013e3182632540.

Tenofovir in second-line ART in Zambia and South Africa: collaborative analysis of cohort studies

Gilles Wandeler  1 , Olivia Keiser, Lloyd Mulenga, Christopher J Hoffmann, Robin Wood, Thom Chaweza, Alana Brennan, Hans Prozesky, Daniela Garone, Janet Giddy, Cleophas Chimbetete, Andrew Boulle, Matthias Egger; IeDEA Southern Africa Collaboration
Affiliations

Tenofovir in second-line ART in Zambia and South Africa: collaborative analysis of cohort studies

Gilles Wandeler et al. J Acquir Immune Defic Syndr. .

Abstract

Objectives: Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA).

Methods: Patients aged 16 years and older starting protease-inhibitor-based second-line ART in Zambia (1 cohort) and RSA (5 cohorts) were included. We compared mortality, immunological failure (all cohorts), and virological failure (RSA only) between patients receiving and not receiving TDF. Competing risk models and Cox models adjusted for age, sex, CD4 count, time on first-line ART, and calendar year were used to analyze mortality and treatment failure, respectively. Hazard ratios (HRs) were combined in fixed-effects meta-analysis.

Findings: 1687 patients from Zambia and 1556 patients from RSA, including 1350 (80.0%) and 206 (13.2%) patients starting TDF, were followed over 4471 person-years. Patients on TDF were more likely to have started second-line ART in recent years and had slightly higher baseline CD4 counts than patients not on TDF. Overall, 127 patients died, 532 were lost to follow-up, and 240 patients developed immunological failure. In RSA, 94 patients had virologic failure. Combined HRs comparing TDF with other regimens were 0.60 (95% confidence interval [CI]: 0.41 to 0.87) for immunologic failure and 0.63 (0.38-1.05) for mortality. The HR for virologic failure in RSA was 0.28 (0.09-0.90).

Conclusions: In this observational study, patients on TDF-containing second-line ART were less likely to develop treatment failure than patients on other regimens. TDF seems to be an effective component of second-line ART in southern Africa.

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Conflict of interest statement

Conflicts of Interest: None reported.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of immunological failure in Zambia (A) and virological failure in the Republic of South Africa (B) during the first three years of second-line ART. TDF, tenofovir.
FIGURE 2
FIGURE 2
Retention in care by second-line ART category and country.
FIGURE 3
FIGURE 3
The risk of treatment failure and death on secondline ART containing and not containing tenofovir in Zambia and the Republic of South Africa. The estimates shown are hazard ratios (HR) for immunological and virological failure and subdistribution hazard ratios (sHR) for mortality.
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