Journal article
Rates and factors associated with major modifications to First-Line combination antiretroviral therapy: Results from the Asia-Pacific region
PLoS ONE, Vol.8(6)
2013
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.
Details
- Title
- Rates and factors associated with major modifications to First-Line combination antiretroviral therapy: Results from the Asia-Pacific region
- Authors/Creators
- M. Wainberg (Author/Creator)S. Wright (Author/Creator) - Kirby InstituteM.A. Boyd (Author/Creator) - St Vincent's Hospital SydneyE. Yunihastuti (Author/Creator) - Rumah Sakit Umum Pusat Nasional Dr. Cipto MangunkusumoM. Law (Author/Creator) - Kirby InstituteT. Sirisanthana (Author/Creator) - Chiang Mai UniversityJ. Hoy (Author/Creator) - Monash UniversityS. Pujari (Author/Creator) - National Institute for Communicable Disease Control and PreventionM.P. Lee (Author/Creator) - Queen Elizabeth HospitalK. Petoumenos (Author/Creator) - Kirby InstituteD. Nolan (Author/Creator)
- Publication Details
- PLoS ONE, Vol.8(6)
- Publisher
- Public Library of Science
- Identifiers
- 991005542603507891
- Copyright
- © 2013 Wright et al.
- Murdoch Affiliation
- Murdoch University
- Language
- English
- Resource Type
- Journal article
- Additional Information
- David Nolan appears courtesy of the Asia-Pacific HIV Observational Database (APHOD)
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- 1 Clinical & Life Sciences
- 1.66 HIV
- 1.66.11 HIV/AIDS Prevention
- Web Of Science research areas
- Infectious Diseases
- ESI research areas
- Immunology