Comparison of Treatment Outcomes among Second-Line Antiretroviral Regimens in HIV/AIDS Patient

Winda Dwi Puspitasari(1*), Nanang Munif Yasin(2), Fita Rahmawati(3)

(1) Graduate Program of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(2) Faculty of Pharmacy, Universitas Gadjah Mada
(3) Faculty of Pharmacy, Universitas Gadjah Mada
(*) Corresponding Author


Antiretroviral (ARV) therapy can increase life expectancy of people living with HIV/AIDS (PLWHA). If the therapy fails and causes severe toxicity to first-line ARV, the first-line ARV regimen is switched to the second line. Studies on the outcome of the second-line ARV therapy have not been widely conducted in Indonesia. This study aims to identify the comparison of outcomes of the second-line ARV therapy regimens in HIV/AIDS patients. The study employed retrospective cohort design. Medical record data were collected from patients treated from January 2008 until December 2017 at Dr. Kariadi Hospital of Semarang. The number of samples that met the inclusion criteria was 42 patients. The comparison between incidence of opportunistic infections and survival among the regimens was presented descriptively. The comparison of regimens based on changes in CD4 level was performed by using Kruskal-Wallis test. The switch occurred in 24 patients (57.14%) due to toxicity of the first-line ARV and in 18 patients (42.86%) due to treatment failure. Mean CD4 and viral load during the switches were 164.68 ± 204.98 cells/mm3, 154,726.14 ± 296,797.12 copies/ml respectively. After 6 months of the second-line ARV therapy, there was an increase in CD4 level (p 0.05) among the three regimens after 6 months of the second-line ARV therapy.


HIV/AIDS; second-line antiretroviral; therapeutic outcome

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  1. UNAIDS. Global AIDS Update 2016. Published 2016. Accessed April 6, 2018.
  2. Pusdatin Kemenkes RI. Situasi Penyakit HIV/AIDS Di Indonesia. Jakarta: InfoDATIN, Pusat Data dan Informasi Kementerian Kesehatan RI; 2016.
  3. Kemenkes RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 tentang Pedoman Pengobatan Antiretroviral. Jakarta: Kementerian Kesehatan Republik Indonesia; 2015.
  4. Jensen-Fangel S. The Effectiveness of Highly Active Antiretroviral Therapy in HIV-Infected Patients. Dan Med Bull. 2004;51(4):371–92.
  5. Ferradini L, Ouk V, Segeral O, 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. J Int AIDS Soc. 2011;14(1):14. doi:10.1186/1758-2652-14-14
  6. BNN. Biaya Ekonomi dan Sosial Penyalahgunaan Narkoba di Indonesia. In: Himpunan Hasil Penelitian Badan Narkotika Nasional 2003 Dan 2004. Jakarta: Badan Narkotika Nasional; 2004.
  7. KPAN. Strategi dan Rencana Aksi Nasional 2015-2019 Penanggulangan HIV dan AIDS di Indonesia. Sistem Informasi HIV/AIDS&IMS Online Kemenkes RI. Published 2015. Accessed April 4, 2018.
  8. Chodidjah S, Agustini N, Ungsianik T. Hubungan antara Pengetahuan tentang HIV/AIDS dengan Perilaku Seksual Pranikah pada Remaja. J Keperawatan Indones. 2004;8(2):50-53.
  9. KPAN. Strategi Nasional Penanggulangan HIV dan AIDS 2007-2010. Yayasan Spiritia. Published 2007. Accessed February 6, 2018.
  10. Mehta U, Maartens G. Is It Safe to Switch between Efavirenz and Nevirapine in The Event of Toxicity? Lancet Infect Dis. 2007;7:733-738.
  11. May MT, Vehreschild JJ, Trickey A, et al. Mortality According to CD4 Count at Start of Combination Antiretroviral Therapy among HIV-infected Patients Followed for up to 15 Years after Start of Treatment: Collaborative Cohort Study. Clin Infect Dis. 2016;62(12):1571-1577. doi:10.1093/cid/ciw183
  12. De Luca A, Sidumo ZJ, Zanelli G, et al. Accumulation of HIV-1 Drug Resistance in Patients on a Standard Thymidine Analogue-Based First Line Antiretroviral Therapy After Virological Failure: Implications for the Activity of Next-Line Regimens from a Longitudinal Study in Mozambique. BMC Infect Dis. 2017;17(1):605. doi:10.1186/s12879-017-2709-x
  13. Palombi L, Marazzi MC, Guidotti G, et al. Incidence and Predictors of Death, Retention, and Switch to Second‐Line Regimens in Antiretroviral‐Treated Patients in Sub‐Saharan African Sites with Comprehensive Monitoring Availability. Clin Infect Dis. 2009;48(1):115-122. doi:10.1086/593312
  14. Manosuthi W, Wiboonchutikul S, Sungkanuparph S. Integrated Therapy for HIV and Tuberculosis. AIDS Res Ther. 2016;13(1):1-12. doi:10.1186/s12981-016-0106-y
  15. Ramadhani HO, Bartlett JA, Thielman NM, et al. The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections among Patients Infected with Human Immunodeficiency Virus in Northern Tanzania. Open Forum Infect Dis. 2016;3(1):ofw018. doi:10.1093/ofid/ofw018
  16. Thao VP, Quang VM, Wolbers M, et al. Second-Line HIV Therapy Outcomes and Determinants of Mortality at the Largest HIV Referral Center in Southern Vietnam. Medicine (Baltimore). 2015;94(43):e1715. doi:10.1097/MD.0000000000001715
  17. Tsegaye AT, Wubshet M, Awoke T, Addis Alene K. Predictors of Treatment Failure on Second-Line Antiretroviral Therapy Among Adults in Northwest Ethiopia: A Multicentre Retrospective Follow-up Study. BMJ Open. 2016;6(12):e012537. doi:10.1136/bmjopen-2016-012537
  18. Soorju V, Naidoo P. Confirmation of Factors That Influence Antiretroviral Regimen Change and the Subsequent Patient Outcomes at a Regional Hospital in Rural Kwazulu-Natal. African J Prim Heal Care Fam Med. 2016;8(1):1-6. doi:10.4102/phcfm.v8i1.1171
  19. Patel D, Desai M, Shah AN, Dikshit RK. Early Outcome of Second Line Antiretroviral Therapy in Treatment-Experienced Human Immunodeficiency Virus Positive Patients. Perspect Clin Res. 2013;4(4):215-220. doi:10.4103/2229-3485.120170
  20. Hakim JG, Thompson J, Kityo C, et al. Lopinavir Plus Nucleoside Reverse-Transcriptase Inhibitors, Lopinavir Plus Raltegravir, or Lopinavir Monotherapy for Second-Line Treatment of HIV (EARNEST): 144-Week Follow-up Results from a Randomised Controlled Trial. Lancet Infect Dis. 2017;18(1):47-57. doi:10.1016/S1473-3099(17)30630-8
  21. WHO. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization; 2013. 22. Wandeler G, Rohr J, Chi BH, et al. Tenofovir or Zidovudine in Second-Line Antiretroviral Therapy After Stavudine Failure in Southern Africa. Antivir Ther. 2014;19(5):521-525. doi:10.3851/IMP2710 23. Ford N, Shubber Z, Hill A, et al. Comparative Efficacy of Lamivudine and Emtricitabine: A Systematic Review and Meta-Analysis of Randomized Trials. Wainberg M, ed. PLoS One. 2013;8(11):e79981. doi:10.1371/journal.pone.0079981


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