Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017;10(1):1290916.
doi: 10.1080/16549716.2017.1290916.

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Nang Thu Thu Kyaw  1 , Ajay M V Kumar  2   3 , Myo Minn Oo  1 , Htun Nyunt Oo  4 , Khine Wut Yee Kyaw  1 , Soe Thiha  1 , Thet Ko Aung  1 , Than Win  4 , Yin Yin Mon  1 , Anthony D Harries  3   5
Affiliations

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar

Nang Thu Thu Kyaw et al. Glob Health Action. 2017.

Abstract

Background: Myanmar has a high burden of Human Immunodeficiency Virus (HIV) and second-line antiretroviral treatment (ART) has been available since 2008 in the public health sector. However, there have been no published data about the outcomes of such patients until now.

Objective: To assess the treatment and programmatic outcomes and factors associated with unfavorable outcomes (treatment failure, death and loss to follow-up from care) among people living with HIV (aged ≥ 10 years) receiving protease inhibitor-based second-line ART under the Integrated HIV Care Program in Myanmar between October 2008 and June 2015.

Design: Retrospective cohort study using routinely collected program data.

Results: Of 824 adults and adolescents on second-line ART, 52 patients received viral load testing and 19 patients were diagnosed with virological failure. However, their treatment was not modified. At the end of a total follow-up duration of 7 years, 88 (11%) patients died, 35 (4%) were lost to follow-up, 21 (2%) were transferred out to other health facilities and 680 (83%) were still under care. The incidence rate of unfavorable outcomes was 7.9 patients per 100 person years follow-up. Patients with a history of injecting drug use, with a history of lost to follow-up, with a higher baseline viral load and who had received didanosine and abacavir had a higher risk of unfavorable outcomes. Patients with higher baseline C4 counts, those having taken first-line ART at a private clinic, receiving ART at decentralized sites and taking zidovudine and lamivudine had a lower risk of unfavorable outcomes.

Conclusions: Long-term outcomes of patients on second-line ART were relatively good in this cohort. Virological failure was relatively low, possibly because of lack of viral load testing. No patient who failed on second-line ART was switched to third-line treatment. The National HIV/AIDS Program should consider making routine viral load monitoring and third-line ART drugs available after a careful cost-benefit analysis.

Keywords: HIV; died; lost to follow-up; operational research; virological failure.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Number of patients and cumulative probability of virological failure in second-line ART cohort at IHC, Myanmar between 2008 and 2015.
Figure 2.
Figure 2.
Number of patients and cumulative probability of death and lost to follow-up combined in second-line ART cohort at IHC, Myanmar between 2008 and 2015.
Figure 3.
Figure 3.
Number of patients and cumulative probability of unfavorable outcomes (failure, death and lost to follow-up combined) in second-line ART cohort at IHC, Myanmar between 2008 and 2015.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. WHO |Global AIDS Update [Internet] WHO. 2016. [cited 2016 June 7]. Available from: http://www.who.int/hiv/pub/arv/global-aids-update-2016-pub/en/
    1. Chakravarty J, Sundar S, Chourasia A, et al. Outcome of patients on second line antiretroviral therapy under programmatic condition in India. BMC Infect Dis. 2015;15:517. 2. - PMC - PubMed
    1. Ajose O, Mookerjee S, Mills EJ, et al. Treatment outcomes of patients on second-line antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis. AIDS Lond Engl. 2012;26:929–11. - PubMed
    1. Thao VP, Quang VM, Wolbers M, et al. Second-line HIV therapy outcomes and determinants of mortality at the largest HIV referral center in southern Vietnam. Medicine (Baltimore). 2015;94:e1715. - PMC - PubMed
    1. Levison JH, Orrell C, Gallien S, et al. Virologic failure of protease inhibitor-based second-line antiretroviral therapy without resistance in a large HIV treatment program in South Africa. Plos One. 2012;7:e32144. - PMC - PubMed

Substances

LinkOut - more resources