African Health Sciences
Makerere University Medical School
Vol. 20, No. 2, 2020, pp. 549-559
Bioline Code: hs20018
Full paper language: English
Document type: Study
Document available free of charge
African Health Sciences, Vol. 20, No. 2, 2020, pp. 549-559
© Copyright 2020 - Rudman C et al.
A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa|
Rudman, Christian; Viljoen, Michelle & Rheeders, Malie
Background: Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the
need for third-line ART (TLART) in a resource-limited setting.
Objective: To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the
North West province.
Method: All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult
patient health records (2002-2017) and analysed.
Results: 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years
(39.5-47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was
101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269
(765-2 343); 1 512 (706-2096) and 71 (58-126) days respectively.
High-level resistance most prevalent were: nelfinavir/r (85.7%), indinavir/r (80.9%), lopinavir/r (76.2%), emtricitabine and
lamivudine (95.2%), nevirapine (76.2%) and efavirenz (71.4%). Resistance to 3 major PI mutations in 95% of patients and
cross resistance were documented extensively.
Conclusion: This study support the need for earlier resistance testing. It firstly reported on time duration post diagnosis on
various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts.
HIV; Human immunodeficiency virus; third-line antiretroviral therapy; drug resistance patterns; salvage therapy