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Published on: October 6, 2022
Long-term treatment outcome and mutational analysis of patients on third-line antiretroviral therapy in programmatic
Jaya Chakravarty1, Shweta Srivastva1, Anurag Kumar Kushwaha1
1Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
Insights
Standardized third-line antiretroviral therapy (ART) shows good long-term outcomes for people with HIV in India. Few drug resistance mutations were observed in patients experiencing treatment failure, indicating treatment effectiveness.
Area of Science:
- Infectious Diseases
- Virology
- Public Health
Background:
- Real-world data on third-line antiretroviral therapy (ART) in low- and middle-income countries are limited.
- Most patients in these regions receive standardized third-line ART through national programs.
- This study focuses on outcomes in an Indian ART center.
Purpose of the Study:
- To assess long-term survival rates.
- To evaluate virological outcomes in patients on third-line ART.
- To analyze drug resistance mutations in individuals with HIV.
Main Methods:
- Eighty-five patients initiated third-line ART between July 2016 and December 2019.
- Genotypic resistance testing was performed at the start of therapy and for those with virological failure at 12 months.
- Drug resistance mutations were analyzed in integrase, reverse transcriptase, and protease genes.
Main Results:
- Survival was 72% at the end of follow-up (March 2022).
- Virological suppression was achieved in 88% of patients at the end of follow-up.
- Major integrase and protease mutations were present in a minority of patients, even before starting third-line ART, and were infrequent in those failing therapy.
Conclusions:
- Standardized third-line ART demonstrates favorable long-term outcomes in programmatic settings.
- Limited drug resistance mutations were observed in patients experiencing treatment failure.
- This highlights the effectiveness of current third-line ART regimens in resource-limited settings.
Background:
In low- and middle-income countries where most patients receive standardized third-line ART through national programmes, real-world data are scarce. This study was done to assess the long-term survival, and virological and mutational outcomes of people living with HIV receiving third-line ART between July 2016 and December 2019 in an ART centre in India.
Methods:
Eighty-five patients were started on third-line ART. Genotypic resistance testing to identify drug resistance mutations in the integrase, reverse transcriptase and protease genes was done at the start of third-line therapy, as well as in those who did not attain virological suppression after 12 months of therapy.
Results:
Survival was 85% (72/85) at 12 months and 72% (61/85) at the end of follow-up in March 2022. Virological suppression was present in 82% (59/72) and 88% (59/67) at 12 months and at the end of follow-up, respectively. Five out of 13 patients who had virological failure at 12 months showed virological suppression at the end of the study. At the start of third-line therapy, 35% (14/40) and 45% (17/38) of patients had major integrase- and protease-associated mutations, respectively, even though they had never been on integrase inhibitor-based regimens. At 1 year follow-up, among those failing third-line therapy, 33% (4/12) of patients had major integrase mutations, but none had major protease mutations.
Conclusions:
This study demonstrates good long-term outcome in patients on standardized third-line ART in programmatic conditions with very few mutations in those failing the therapy.
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