1. High rates of survival, virologic suppression and immune reconstitution among patients receiving second-line ART in the Indian national programme B.B. Rewari 1, M. Shaukat 1, S. Kabra 1, P. Srikantiah 2 1 National AIDS Control Organisation, New Delhi, India 2 University of California, San Francisco, San Francisco, USA XIX International AIDS Conference Washington, D.C. 26 July 2012

2. Background, Objectives, Methods Indian National ART Programme 540,000 persons receive standard first-line ART using public health approach – CD4 cell count every 6 months, no routine VL testing Second-line ART program rolled out across 10 COEs in 2009 – Patients with WHO-defined immunologic and/or clinical failure referred for expert clinical evaluation and viral load testing – Patients with VL >5,000 c/mL started on TDF/3TC/AZT/LPV/rtv* – Standard clinical/CD4 assessment, VL checked after 6 months Objectives: Evaluate 12 and 18 month outcomes of second-line ART patients Examine predictors of virologic suppression, mortality, retention in care Methods: Standardized clinical and laboratory data collected on all adult patients starting second-line ART in India between January 1 and June 30, 2010 * Second-line Regimen changed to TDF/Atazanvir/ritonavir in March 2011

3. Characteristics and Outcomes of Second-line ART Patients (n=411) 73% Immunologic failure, 13% Immunologic and/or Clinical Failure

4. Retention in Care: Factors associated with being Alive and on ART at 12 and 18 months

5. Conclusions and Implications Despite advanced disease at the time of treatment switch, overall patients responded well to standard second-line ART – Good immunologic response and survival – Most surviving patients achieved virologic suppression at 6 months Poor outcomes at 12 and 18 months associated with presence of clinical failure and profound immunosuppression (CD4 <50) at treatment switch – Highlights critical importance of CD4 monitoring in first-line therapy for earlier detection of immunologic failure – Where feasible, routine virologic monitoring in first-line ART can assist earlier identification of failure