High efficacy of lopinavir/r-based second-line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia.

Laurent Ferradini (1) , Vara Ouk (2) , Olivier Segeral (2, 3) , Janin Nouhin (4) , Anne Dulioust (2, 3) , Chanroeurn Hak (2) , Isabelle Fournier (5) , Nathalie Lerolle (3) , Sopheak Ngin (4) , Chhi Vun Mean (6) , Jean-François Delfraissy (3, 7) , Eric Nerrienet (4)

1 FHI - Family Health International
2 ESTHER/Hospital Calmette
3 Département d'immunologie clinique
4 Institut Pasteur du Cambodge
5 ANRS Cambodge
6 NCHADS - National Center for HIV/AIDS, Dermatology and STD
7 ANRS France Recherche Nord & sud Sida-hiv hépatites

BACKGROUND: The number of patients on second-line highly active antiretroviral therapy (HAART) regimens is increasing in resource-limited settings. We describe the outcomes after 24 months for patients on LPV/r-based second-line regimens followed up by the ESTHER programme in Phnom Penh, Cambodia. METHODS: Seventy patients who initiated second-line HAART regimens more than 24 months earlier were included, and immuno-virological data analyzed. HIV RNA viral load was determined by real-time RT-PCR. HIV-1 drug resistance was interpreted according to the ANRS algorithm. RESULTS: Of the 70 patients, two were lost to follow up, three died and 65 (92.8%) remained on second-line treatment after 24 months of follow up (median duration of treatment: 27.4 months). At switch to second-line, the median CD4 T cell count was 106 cells/mm³ and the median viral load was 4.7 Log10. Second-line regimens prescribed were ddI/3TC/LPV/r (65.7%), ddI/TDF/LPV/r (10.0%), ddI/AZT/LPV/r (8.6%) and TDF/3TC/LPV/r (7.1%). The median CD4 T cell gain was +258 cells/mm³ at 24 months (n = 63). After 24 months of follow up, 92.3% (60/65) of the patients presented undetectable viral loads, giving an overall treatment success rate of 85.7% (CI: 75.6- 92.0) in intent-to-treat analysis. CONCLUSIONS: These data suggest that a LPV/r-based second-line regimen is associated with a high rate of virological suppression and immune reconstitution after 24 months of follow up in Cambodia.

Domaines: Médecine humaine et pathologie

Laurent Ferradini, Vara Ouk, Olivier Segeral, Janin Nouhin, Anne Dulioust, et al.. High efficacy of lopinavir/r-based second-line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia.. Journal of the International AIDS Society, 2011, 14, pp.14. ⟨10.1186/1758-2652-14-14⟩. ⟨pasteur-00598973⟩