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Home >> Publications >> Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region.

Publication

Author(s):

Wright S, Boyd MA, Yunihastuti E, Law M, Sirisanthana T, Hoy J, Pujari S, Lee MP, Petoumenos K; International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific HIV Observational Database (APHOD).

Pub Title:

Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region.

Pub Date:

Jun 28 2013

Pub Region(s):

Asia-Pacific

Journal Issue:

8(6)

Page Number:
e64902

Journal:

Title: 
PLoS One
Link: 
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0064902

PubMed: 23840312
Pub PDF:

Abstract
BACKGROUND
: In 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.

METHODS: We 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.

RESULTS: A 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.

CONCLUSIONS: Low-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.

PMID: 23840312 [PubMed - in process]

PMCID: PMC3696001

 

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Citation:

Wright S, Boyd MA, Yunihastuti E, Law M, Sirisanthana T, Hoy J, Pujari S, Lee MP, Petoumenos K; International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific HIV Observational Database (APHOD). Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region. PLoS One. 2013 Jun 28;8(6):e64902. doi: 10.1371/journal.pone.0064902. Print 2013. PubMed PMID: 23840312; PubMed Central PMCID: PMC3696001.