Author(s)

Ndeye Fatou Ngom-Gueye^1,2*, Gilbert Batista¹, Abdoul Aziz Ndiaye², Assane Diouf³, KA. Daye³, Alioune Badara Tall², Awa Diouf¹, Kine Ndiaye¹, Makhtar Ndiaga Diop¹, Mountaga Dia², Cheikh Tacko Diop², Awa Gaye², Cheikh Tidiane Ndour³, Moussa Seydi³, Lamine Gueye², Bernard Marcel Diop¹, Papa Salif Sow³

¹Ambulatory Treatment Center, Fann University Teaching Hospital, Dakar, Senegal.
²Department of Community Health, Alioune Diop University, Bambey, Senegal.
³Department of Infectious Diseases, Fann University Teaching Hospital, Dakar, Senegal.

Introduction: Over the past years, efforts have been made to expand access to antiretroviral combinations (cART) in low-income countries. However, major concerns are noted with drug resistance emergence, as treatment failure result and need to introduce a second line treatment, more expensive and difficult to implement. The objective was to study the incidence of switch to second line, reasons for switch and risk factors using a cohort of people living with HIV in an Ambulatory Treatment Center in Dakar. Methodology: This was a cohort study of people living with HIV under cART from January 2004 to December 2013. Naive patients monitored for at least six months, regardless of their profile and regimen with baseline CD4 counts < 350 cells/mm³ were included in this study. Results: The median age of the 827 patients included was 44 [IQR = 18 - 78]. The switch to second-line treatment was observed in 72 patients (8.7%) after an average of 38.5 months of follow-up. The overall incidence rate of switch to second line of antiretroviral treatment was 1.59 per 100 persons-years. Most of changes in first-line treatment were motivated by virological failures (n = 60, 83.3%) under treatment with AZT/3TC/NVP (n = 25, 34.7%) or AZT/3TC/EFV21 (29.2%). 9.7% of switch occurred after immunological failure, 1.4% after clinical failure, 4.2% after severe toxicity and 1.4% was not documented. Predictive factors identifying failures at the end of the multivariate analysis were age < 44 years and CD4 counts below 100 cells/mm³. Conclusions: In total, CTA identified a low incidence rate of treatment failure of the first line of treatment. Associated risk factors were age < 44 years, CD4 counts below 100 cells/mm³ and high viral load at treatment initiation.

Incidence, Associated Factors, Switch to 2nd Line cART, CTA, Dakar

Ngom-Gueye, N. , Batista, G. , Ndiaye, A. , Diouf, A. , Daye, K. , Tall, A. , Diouf, A. , Ndiaye, K. , Diop, M. , Dia, M. , Diop, C. , Gaye, A. , Ndour, C. , Seydi, M. , Gueye, L. , Diop, B. and Sow, P. (2016) Incidence and Factors Associated with the Switch to the Second Line Antiretroviral Treatment at the Ambulatory Treatment Center (CTA) in Dakar. Health, 8, 1566-1575. doi: 10.4236/health.2016.814154.