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Objectives  To report predictors of outcomes of second‐line  ART  for  HIV  treatment in a resource‐limited setting.    Methods  All adult  ART ‐naïve patients who initiated standard first‐line treatment between April 2004 and February 2012 at four public‐sector health facilities in Johannesburg, South Africa, experienced virologic failure and initiated standard second‐line therapy were included. We assessed predictors of attrition (death and loss to follow‐up [≥3 months late for a scheduled visit]) using Cox proportional hazards regression and predictors of virologic suppression (viral load <400 copies/ml ≥3 months after switch) using modified Poisson regression with robust error estimation at 1 year and ever after second‐line  ART  initiation.    Results  A total of 1236 patients switched to second‐line treatment in a median ( IQR ) of 1.9 (0.9‐4.6) months after first‐line virologic failure. Approximately 13% and 45% of patients were no longer in care at 1 year and at the end of follow‐up, respectively. Patients with low  CD 4 counts (<50 vs. ≥200,  aHR : 1.85; 95%  CI : 1.03–3.32) at second‐line switch were at greater risk for attrition by the end of follow‐up. About 75% of patients suppressed by 1 year, and 85% had ever suppressed by the end of follow‐up.    Conclusions  Patients with poor immune status at switch to second‐line  ART  were at greater risk of attrition and were less likely to suppress. Additional adherence support after switch may improve outcomes.

tropical medicine and international health

Treatment outcomes of over 1000 patients on second‐line, protease inhibitor‐based antiretroviral therapy from four public‐sector  HIV  treatment facilities across Johannesburg, South Africa