TY - JOUR
T1 - Treatment modification after second-line failure among people living with HIV in Asia-Pacific
AU - the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific
AU - Jiamsakul, Awachana
AU - Azwa, Iskandar
AU - Zhang, Fujie
AU - Yunihastuti, Evy
AU - Ditangco, Rossana
AU - Kumarasamy, Nagalingeswaran
AU - Ng, Oon Tek
AU - Chan, Yu Jiun
AU - Ly, Penh Sun
AU - Choi, Jun Yong
AU - Lee, Man Po
AU - Pujari, Sanjay
AU - Kiertiburanakul, Sasisopin
AU - Chaiwarith, Romanee
AU - Merati, Tuti Parwati
AU - Sangle, Shashikala
AU - Khusuwan, Suwimon
AU - Sim, Benedict L.H.
AU - Avihingsanon, Anchalee
AU - Do, Cuong Duy
AU - Tanuma, Junko
AU - Ross, Jeremy
AU - Law, Matthew
N1 - Funding Information:
The TREAT Asia HIV Observational Database and The TREAT Asia HIV Observational Database Low-Intensity TransfEr 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, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. A list of the site investigators and study teams can be found in Additional file 1.
Publisher Copyright:
© 2020 International Medical Press
PY - 2021/4/12
Y1 - 2021/4/12
N2 - Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.
AB - Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.
UR - http://www.scopus.com/inward/record.url?scp=85106544855&partnerID=8YFLogxK
U2 - 10.3851/IMP3388
DO - 10.3851/IMP3388
M3 - Article
C2 - 33843656
AN - SCOPUS:85106544855
SN - 1359-6535
VL - 25
SP - 377
EP - 387
JO - Antiviral Therapy
JF - Antiviral Therapy
IS - 7
ER -
