TY - JOUR
T1 - Patterns and prognosis of holding regimens for people living with HIV in Asian countries
AU - IeDEA Asia-Pacific
AU - Kim, Jung Ho
AU - Jiamsakul, Awachana
AU - Kiertiburanakul, Sasisopin
AU - Huy, Bui Vu
AU - Khusuwan, Suwimon
AU - Kumarasamy, Nagalingeswaran
AU - Ng, Oon Tek
AU - Ly, Penh Sun
AU - Lee, Man Po
AU - Chan, Yu Jiun
AU - Gani, Yasmin Mohamed
AU - Azwa, Iskandar
AU - Avihingsanon, Anchalee
AU - Merati, Tuti Parwati
AU - Pujari, Sanjay
AU - Chaiwarith, Romanee
AU - Zhang, Fujie
AU - Tanuma, Junko
AU - Do, Cuong Duy
AU - Ditangco, Rossana
AU - Yunihastuti, Evy
AU - Ross, Jeremy
AU - Choi, Jun Yong
AU - Khol, V.
AU - Zhao, H. X.
AU - Han, N.
AU - Li, P. C.K.
AU - Lam, W.
AU - Chan, Y. T.
AU - Ezhilarasi, C.
AU - Joshi, K.
AU - Gaikwad, S.
AU - Chitalikar, A.
AU - Sangle, S.
AU - Mave, V.
AU - Marbaniang, I.
AU - Nimkar, S.
AU - Wirawan, D. N.
AU - Yuliana, F.
AU - Widhani, A.
AU - Maria, S.
AU - Karjadi, T. H.
AU - Oka, S.
AU - Nishijima, T.
AU - Na, S.
AU - Kim, J. M.
AU - Rudi, N. B.
AU - Kamarulzaman, A.
AU - Omar, S. F.Syed
AU - Ponnampalavanar, S.
N1 - Funding Information:
The TAHOD and TAHOD-LITE studies are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions above.
Publisher Copyright:
© 2022 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/3
Y1 - 2022/3
N2 - The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.
AB - The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.
UR - http://www.scopus.com/inward/record.url?scp=85127235116&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0264157
DO - 10.1371/journal.pone.0264157
M3 - Article
C2 - 35353840
AN - SCOPUS:85127235116
SN - 1932-6203
VL - 17
JO - PloS one
JF - PloS one
IS - 3 March
M1 - e0264157
ER -
