The causal effect of switching to second-line ART in programmes without access to routine viral load monitoring

Autor: Gsponer T, Petersen M, Egger M, Phiri S, Maathuis MH, Boulle A, Musondad P, Tweya H, Peter K, Chi BH, Keiser O
Rok vydání: 2012
Zdroj: AIDS
Popis: Objectives: We examined the effect of switching to second line antiretroviral therapy (ART) on mortality in patients who experienced immunological failure in ART programmes without access to routine viral load monitoring in sub Saharan Africa. Design and setting: Collaborative analysis of two ART programmes in Lusaka Zambia and Lilongwe Malawi. Methods: We included all adult patients experiencing immunological failure based on WHO criteria. We used Cox proportional hazards models weighted by the inverse probability of switching to compare mortality between patients who switched and patients who did not; and between patients who switched immediately and patients who switched later. Results are expressed as hazard ratios with 95 credible intervals (95 CI). Results: Among 2411 patients with immunological failure 324 patients (13.4) switched to second line ART during 3932 person years of follow up. The median CD4 cell count at start of ART and failure was lower in patients who switched compared to patients who did not: 80 versus 155?cells/µl (P?0.001) and 77 versus 146?cells/µl (P?
Databáze: OpenAIRE
Externí odkaz: