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Home >> Publications >> Antiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for 'test and treat' prevention strategy.

Publication

Author(s):

Guy R, Wand H, McManus H, Vonthanak S, Woolley I, Honda M, Read T, Sirisanthana T, Zhou J, Carr A; Australia HIV Observational Database (AHOD) and Treat Asia HIV Observation Database (TAHOD).

Pub Title:

Antiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for 'test and treat' prevention strategy.

Pub Date:

Dec 31 2013

Pub Region(s):

Asia-Pacific

Journal:

Title: 
AIDS Patient Care and STDs
Link: 
http://online.liebertpub.com/doi/abs/10.1089/apc.2012.0439

PubMed: 24320013
Pub PDF: PDF icon 24320013.pdf

Abstract
Both antiretroviral treatment interruption (TI) and cessation have been strongly discouraged since 2006. We describe the incidence, duration, and risk factors for TI and loss-to-follow-up (LTFU) rates across 13 countries. All 4689 adults (76% men) in two large HIV cohorts in Australia and Asia commencing combination antiretroviral therapy (ART) to March 2010 were included. TI was defined by ART cessation >30 days, then recommencement, and loss to follow-up (LTFU) by no visit since 31 March 2009 and no record of death. Survival analysis and Poisson regression methods were used. With median follow-up of 4.4 years [interquartile range (IQR):2.1-6.5], TI incidence was 6.7 per 100 person years (PY) (95% CI:6.1-7.3) pre-2006, falling to 2.0 (95% CI:1.7-2.2) from 2006 (p<0.01). LTFU incidence was 3.5 per 100 PY (95% CI:3.1-3.9) pre-2006, and 4.1 (95% CI:3.5-4.9) from 2006 (p=0.22). TIs accounted for 6.4% of potential time on ART pre-2006 and 1.2% from 2006 (p<0.01), and LTFU 4.7% of potential time on ART pre-2006 and 6.6% from 2006 (p<0.01). Median TI duration was 163 (IQR: 75-391) days pre-2006 and 118 (IQR: 67-270) days from 2006 (p<0.01). Independent risk factors for the first TI were: Australia HIV Observational Database participation; ART initiation pre-2006; ART regimens including stavudine and didanosine; three nucleoside analogue reverse transcriptase inhibitors; ≥7 pills per day; and ART with food restrictions (fasting or with food). In conclusion, since 2006, 7.8% of patients had significant time off treatment, which has the potential to compromise any 'test and treat' policy as during the interruption viral load will rebound and increase the risk of transmission.

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Citation:

Guy R, Wand H, McManus H, Vonthanak S, Woolley I, Honda M, Read T, Sirisanthana T, Zhou J, Carr A; Australia HIV Observational Database (AHOD) and Treat Asia HIV Observation Database (TAHOD). Antiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for 'test and treat' prevention strategy. AIDS Patient Care STDS. 2013 Dec;27(12):681-91. doi: 10.1089/apc.2012.0439. PubMed PMID: 24320013; PubMed Central PMCID: PMC3868400.