A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa

Background: Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the need for third-line ART (TLART) in a resource-limited setting.
Objective: To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the North West province.
Method: All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult patient health records (2002-2017) and analysed.
Results: 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years (39.5-47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was 101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269 (765-2 343); 1 512 (706-2096) and 71 (58-126) days respectively.
High-level resistance most prevalent were: nelfinavir/r (85.7%), indinavir/r (80.9%), lopinavir/r (76.2%), emtricitabine and lamivudine (95.2%), nevirapine (76.2%) and efavirenz (71.4%). Resistance to 3 major PI mutations in 95% of patients and cross resistance were documented extensively.
Conclusion: This study support the need for earlier resistance testing. It firstly reported on time duration post diagnosis on various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts.

Keywords
HIV; Human immunodeficiency virus; third-line antiretroviral therapy; drug resistance patterns; salvage therapy