Introduction: Human immunodeficiency virus (HIV) drug resistance has been a significant contributor to failure of
combined antiretroviral therapy (cART). Once the resistance has occurred, combating it is extremely difficult given the presence
of minority variants that may have selective advantage. Patient failing a cART regimen mostly have drug resistant mutations.
Optimal and prolonged viral suppression has been shown to significantly reduce the risk of accumulation of resistant variants,
hence prolongs duration of effectiveness of the regimen. Objective: To assess the virologic, immunologic, clinical and safety
outcomes among patients on second-line cART and to describe the patterns of HIVDR mutations among these patients.
Methodology: The study was a descriptive retrospective review to evaluate the outcomes and the drug resistance pattern of PLHIV
among patients on second-line cART at HTAR, Klang, Malaysia. Results and discussion: A total of 47 patients were evaluated
for outcomes on second line cART. Majority of them (76.6%) was changed to second-line due to treatment failure, 17% due toxicity
and 6.4% had psychiatric symptoms. The median (IQR) viral load level decrease at 6 months to 20 (20-109) copies/mL from 20,022
(2208-123845) copies/ml at the time of starting second-line cART; the median (IQR) CD4 cell count at 6 months increased to 291
(220-497) cells/mm3
compared to the time of change 203 ((50-425) cells/mm3. At 6 months there was a significant mean increase
of weight by 1.8 kg ± 5 (95% CI: 0.7- 4.9) (P = 0.01). Among patient with treatment failure, 42% (17/36) had drug sensitivity
testing: 16.7% (3/17) had single class mutation, 70% (12/17) had double class mutation while 12% (2/17) had triple class mutations.
Overall, 88% (15/17) had at least one resistant mutation. Conclusion: Assessment of outcomes of patients on second-line cART is
necessary to ensure treatment goals are achieved and to safeguard the limited options of antiretrovirals available after second-line
therapy.
Key words: Human immunodeficiency virus (HIV), antiretroviral therapy (cART), CD4 cell, HIV drug resistance (HIVDR).
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