Third-line antiretroviral therapy (ART) is associated with high rates of viral suppression among patients with HIV infection who do not respond to second-line regimens, according to study findings published in AIDS Research and Therapy.
These findings come from a systematic review and meta-analysis of 15 studies that were published between 2015 to 2023. Researchers sourced data from these studies to examine virologic outcomes among patients (N=1768) with HIV infection on third-line ART who were unable to achieve viral suppression with second-line regimens.
Of the 15 studies included in the review, 10 were conducted in Africa and 13 were cohort studies. Owing to substantial heterogeneity across the studies (I2 = 86.5%; P <.001), the researchers used a random-effects model to estimate pooled virologic suppression associated with third-line ART.
In the pooled analysis of patients who switched from second- to third-line ART, 76.6% (95% CI, 71.5-81.7) achieved viral suppression.
The researchers also performed a subgroup analysis, controlling for publication year, patient age, study quality, country income level, duration of virologic suppression, and number of viral RNA copies. The analysis revealed similar findings among patients who switched to third-line ART, with high rates of viral suppression observed at 6 and 12 months (75.5% and 78.6%, respectively) and among those in low- to middle-income countries (77.8%; 95% CI, 72.3-83.3).
Overall, 70.7% of patients who switched to third-line ART achieved undetectable HIV viral loads (≤50 copies/mL). Moreover, the rate of viral suppression was similar between older vs younger patients (78.4% vs 78.9%).
Limitations of this analysis include the high level of study heterogeneity as well as reduced generalizability due to geographical bias.
According to the researchers, “Understanding the effectiveness of third-line antiretroviral therapy in individuals who do not respond to second-line drugs is crucial for improving treatment strategies.”
By Paul Basilio
References:
Kitaw TA, Abate BB, Yilak G, et al. Virological outcomes of third-line antiretroviral therapy in a global context: a systematic review and meta-analysis. AIDS Res Ther. 2024;21(1):43. doi:10.1186/s12981-024-00630-7
Source : Infectious Disease Advisor
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