ZDV was discontinued because of either anaemia or neutropenia in seven patients. In four subjects with renal toxicity, TDF was substituted with ABC, and in one case of lactic acidosis all NRTIs including TDF were discontinued. LPV/r was not discontinued because of toxicity in any patient. Among patients initiating treatment, 55% reported never missing a dose throughout the study period. Likewise, 55% of patients never missed a clinic visit but 29% of patients missed one visit, 11% missed two visits, and 5% missed three visits. Among survivors, the median increase in CD4 count was 142 cells/μL (IQR 66, 263)

at 12 months and 85% of these patients check details had HIV-1 RNA<400 copies/mL at 12 months (Fig. 3). Overall, 75% of the 101 patients who started second-line therapy survived and were suppressed (Fig. 3). Of the 13 patients who had HIV-1 RNA>400 copies/mL CDK inhibitor at month 12, six were never suppressed and seven had initial suppression but rebounded. On treatment, the HIV-1 RNA suppression rate for patients with wild-type virus was 60% [95% confidence interval (CI) 15–95%]

compared with 94% (95% CI 87–100%) for patients with any TAMs and 95% (95% CI 85–100%) for those with at least three TAMs. HIV-1 RNA suppression rates varied according to the number of active NRTI drugs: at least two active drugs (low), 71% (95% CI 50–93%); one active drug (medium), 92% (95% CI 85–100%); and no active drugs (high), 97% (95% CI 77–100%). Adherence rates (never missed doses) were 48% for those with at least two active

drugs (low), 59% for those with one active drug (medium), and 56% for those with no active drugs (high) (P=0.7), which corresponded to HIV-1 RNA suppression rates of 90% for those with at least two active drugs (low), 96% for those with one active drug (medium), and 89% for those with no active drugs (high) (P=0.6). Among patients who ever missed doses, HIV-1 RNA suppression rates were 55% for those with at least two active drugs (low), 84% for those with one active drug (medium), and 85% for those Etofibrate with no active drugs (high) (P=0.15). Factors associated with HIV-1 RNA>400 copies/mL at 12 months on univariate analysis included having a presenting CD4 count <50 cells/μL and HIV-1 RNA>100 000 copies/mL (Table 3). Paradoxically, having extensive baseline resistance resulted in better virological suppression (Table 3). However, on multivariate analysis, only poor adherence (ever missing a dose) remained statistically significant. Duration on first-line treatment >3 years was not associated with increased risk of failure. In our cohort of ART failure patients identified by clinical and immunological criteria in the public health setting who were confirmed to have virological failure, there is substantial early mortality on second-line ART. Identification of failure by clinical criteria, in particular, was associated with an increased risk of death in the first 6 months as well as new and progressive HIV-associated illnesses.