Further, if proteinuria is identified, uAPR check details may provide useful insights into whether the problem lies with the cART regimen, requiring regimen change, or elsewhere, requiring further enquiry into comorbidity. In our cohort, those with biopsy-proven cART-associated damage were also identified by a high uPCR but a low uAPR, proteinuria resolved after switching cART regimen. In summary, it is important to consider the screening protocol used for urinary protein estimation in HIV-infected individuals. The use of uACR or dipstick urinalysis alone as a screening test for proteinuria may not detect significant tubular dysfunction or alert the clinician
to potential cART-related problems. Our results suggest that measuring both uPCR and uACR on a single sample (and hence obtaining a uAPR) may be both practical and helpful in evaluating proteinuria in selected HIV-infected patients, and may help to identify those in whom a more careful evaluation of tubular dysfunction is warranted. Conflicts of interest: AS has received travel bursaries and scholarships from Boehringer Ingelheim, Bristol Myers Squib, Gilead, Merck Sharp
and Dohme, Tibotec and Viiv Healthcare. KN has received funding for travel, consultancies and teaching purposes from Bristol Myers Squibb, Gilead Sciences and Viiv Healthcare. CS has received funding Daporinad mouse for travel, consultancies and teaching purposes from Gilead Sciences, Bristol Myers Squibb and Janssen-Cilag. MF has received honoraria and/or travelling scholarships from Abbott, Bristol Myers Squibb, Gilead, Janssen, Merck and Viiv Healthcare. YG has received travel bursaries and educational grants from Abbott, Gilead, Tibotec and Viiv Healthcare. SH has received honoraria
from Gilead in the past. “
“The Malawi antiretroviral therapy (ART) programme uses the public health approach to identify ART failure. Advanced disease progression may occur before switching to second-line ART. We report outcomes for patients evaluated and initiated on second-line treatment in Malawi. Patients meeting Malawi immunological or clinical criteria for ART failure in two large urban ART clinics Acesulfame Potassium were evaluated for virological failure (viral load >400 HIV-1 RNA copies/mL) and, if failure was confirmed, initiated on second-line ART (zidovudine/lamivudine/tenofovir/lopinavir/ritonavir). Patients were seen monthly and laboratory evaluations were performed quarterly and as needed. We performed logistic regression modelling to identify factors associated with mortality, mortality or new HIV illnesses, and virological suppression at 12 months. Of the 109 patients with confirmed virological failure, five patients died prior to initiation, three declined switching and 101 patients initiated second-line treatment. Over 12 months, 10 additional patients died, 34 patients experienced 45 HIV-related events, and 19 patients experienced grade 3 or 4 toxicities. Among survivors, 85.2% had HIV-1 RNA<400 copies/mL at 12 months.