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Original article

Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE)

Rosario Martinez-Vega, Nicole L De La Mata, Nagalingeswaran Kumarasamy, Penh Sun Ly, Kinh Van Nguyen, Tuti P Merati, Thi Thanh Pham, Man Po Lee, Jun Yong Choi, Jeremy L Ross, Oon Tek Ng

Corresponding author name: Oon Tek Ng
Corresponding author e-mail: Oon_Tek_NG@ttsh.com.sg

Citation: Antiviral Therapy 2018; 23:167-178
doi: 10.3851/IMP3194

Date accepted: 15 August 2017
Date published online: 21 September 2017

Abstract

Background: The durability of first-line regimen is important to achieve long-term treatment success for the management of HIV infection. Our analysis describes the duration of sequential ART regimens and identifies the determinants leading to treatment change in HIV-positive patients initiating in Asia.

Methods: All HIV-positive adult patients initiating first-line ART in 2003–2013, from eight clinical sites among seven countries in Asia. Patient follow-up was to May 2014. Kaplan–Meier curves were used to estimate the time to second-line ART and third-line ART regimen. Factors associated with treatment durability were assessed using Cox proportional hazards model.

Results: A total of 16,962 patients initiated first-line ART. Of these, 4,336 patients initiated second-line ART over 38,798 person-years (pys), a crude rate of 11.2 (95% CI 10.8, 11.5) per 100 pys. The probability of being on first-line ART increased from 83.7% (95% CI 82.1, 85.1%) in 2003–2005 to 87.9% (95% CI 87.1, 88.6%) in 2010–2013. Third-line ART was initiated by 1,135 patients over 8,078 pys, a crude rate of 14.0 (95% CI 13.3, 14.9) per 100 pys. The probability of continuing second-line ART significantly increased from 64.9% (95% CI 58.5, 70.6%) in 2003–2005 to 86.2% (95% CI 84.7, 87.6%) in 2010–2013.

Conclusions: Rates of discontinuation of first- and second-line regimens have decreased over the last decade in Asia. Subsequent regimens were of shorter duration compared to the first-line regimen initiated in the same year period. Lower CD4+ T-cell count and the use of suboptimal regimens were important factors associated with higher risk of treatment switch.

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