Original Research

Outcomes and characteristics of patients on protease inhibitors at a tertiary level antiretroviral clinic

Michele Perks, Denasha L. Reddy, Francois Venter
Southern African Journal of HIV Medicine | Vol 24, No 1 | a1536 | DOI: https://doi.org/10.4102/sajhivmed.v24i1.1536 | © 2023 Michele Perks, Denasha L. Reddy, Francois Venter | This work is licensed under CC Attribution 4.0
Submitted: 18 September 2023 | Published: 21 December 2023

About the author(s)

Michele Perks, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Denasha L. Reddy, Department of Internal Medicine and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Francois Venter, Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Abstract

Background: Protease inhibitors (PIs) have been recommended as World Health Organization second-line antiretroviral therapy (ART) for low- to middle-income countries for two decades. As dolutegravir-based regimens have become widely available, the future role of PIs is uncertain.

Objectives: To describe the characteristics of patients on PI-based ART (in first-line and second-line regimens), double-boosted protease inhibitors (DBPI) and patients who received recycled nucleoside reverse transcriptase inhibitors (NRTI) in second-line regimens at a tertiary level ART clinic.

Method: We conducted a descriptive retrospective record review of adult patients on PI-based ART who attended Nthabiseng Adult Infectious Diseases Clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa, between January 2021 and April 2022.

Results: Of the 900 patients sampled, 543 (60.3%) were female, the median age was 45 and 703 (79.1%) had viral loads (VL) below 1000 copies/mL. In contrast, 21 (58.3%) of 36 vertically infected patients had VLs below 1000 copies/mL. Thirty-seven (4.1%) patients were on DBPIs. The commonest reason for DBPI use in 24 (64.9%) patients was drug resistance test (DRT)-guided switch after virological failure. Forty-nine (5.4%) patients were on recycled NRTIs with no DRT, and 24 (2.6%) patients were on NRTIs to which there was documented resistance. Outcomes for these patients were similar to the total sample.

Conclusion: PIs have long been a cornerstone of second-line ART. This study demonstrates the real-world utility of PIs, as well as their disadvantages. There was no difference in the outcomes of patients who received recycled NRTIs in second-line regimens.


Keywords

HIV; NRTI recycling; protease inhibitors; antiretrovirals; South Africa.

Sustainable Development Goal

Goal 3: Good health and well-being

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