Rates and Factors Associated with Major Modifications to First-Line Combination Antiretroviral Therapy: Results from the Asia-Pacific Region |
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| Authors: | Stephen Wright Mark A Boyd Evy Yunihastuti Matthew Law Thira Sirisanthana Jennifer Hoy Sanjay Pujari Man Po Lee Kathy Petoumenos on behalf of the International Epidemiologic Databases to Evaluate AIDS |
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| Institution: | 1. Kirby Institute, Sydney, Australia.; 2. St. Vincent’s Hospital, Sydney, Australia.; 3. Cipto Mangunkusumo General Hospital, Jakarta Pusat, Indonesia.; 4. Chiang Mai University, Chiang Mai, Thailand.; 5. The Alfred Hospital, Melbourne, Australia.; 6. Monash University, Melbourne, Australia.; 7. Institute of Infectious Diseases, Pune, India.; 8. Queen Elizabeth Hospital, Kowloon, Hong Kong.; McGill University AIDS Centre, Canada, |
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| Abstract: | BackgroundIn the Asia-Pacific region many countries have adopted the WHO’s public health approach to HIV care and treatment. We performed exploratory analyses of the factors associated with first major modification to first-line combination antiretroviral therapy (ART) in resource-rich and resource-limited countries in the region.MethodsWe selected treatment naive HIV-positive adults from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD). We dichotomised each country’s per capita income into high/upper-middle (T-H) and lower-middle/low (T-L). Survival methods stratified by income were used to explore time to first major modification of first-line ART and associated factors. We defined a treatment modification as either initiation of a new class of antiretroviral (ARV) or a substitution of two or more ARV agents from within the same ARV class.ResultsA total of 4250 patients had 961 major modifications to first-line ART in the first five years of therapy. The cumulative incidence (95% CI) of treatment modification was 0.48 (0.44–0.52), 0.33 (0.30–0.36) and 0.21 (0.18–0.23) for AHOD, T-H and T-L respectively. We found no strong associations between typical patient characteristic factors and rates of treatment modification. In AHOD, relative to sites that monitor twice-yearly (both CD4 and HIV RNA-VL), quarterly monitoring corresponded with a doubling of the rate of treatment modifications. In T-H, relative to sites that monitor once-yearly (both CD4 and HIV RNA-VL), monitoring twice-yearly corresponded to a 1.8 factor increase in treatment modifications. In T-L, no sites on average monitored both CD4 & HIV RNA-VL concurrently once-yearly. We found no differences in rates of modifications for once- or twice-yearly CD4 count monitoring.ConclusionsLow-income countries tended to have lower rates of major modifications made to first-line ART compared to higher-income countries. In higher-income countries, an increased rate of RNA-VL monitoring was associated with increased modifications to first-line ART. |
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