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Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: results from the TREAT Asia HIV observational database.
Boettiger, David C; Nguyen, Van K; Durier, Nicolas; Bui, Huy V; Heng Sim, Benedict L; Azwa, Iskandar; Law, Matthew; Ruxrungtham, Kiat.
Affiliation
  • Boettiger DC; *Biostatistics and Databases Program, The Kirby Institute, UNSW Australia, Sydney, Australia; †National Hospital of Tropical Diseases, Hanoi, Vietnam; ‡TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand; §Infectious Diseases Unit, Department of Medicine, Hospital Sungai Buloh, Sungai Buloh, Malaysia; ‖Faculty of Medicine, Infectious Diseases Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; and ¶HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
J Acquir Immune Defic Syndr ; 68(2): 186-95, 2015 Feb 01.
Article in En | MEDLINE | ID: mdl-25590271
BACKGROUND: Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources, it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. METHODS: HIV-positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. RESULTS: There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells per cubic millimeter, and median HIV viral load was 16,224 copies per milliliter. Patients started second-line ART before 2007 (n = 105), 2007-2010 (n = 147) and after 2010 (n = 50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line therapy was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95% confidence interval: 7.1 to 10.9) and 1.1 (95% confidence interval: 0.6 to 1.9), respectively. Older age, high baseline viral load, and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. CONCLUSIONS: Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: HIV Infections / Anti-Retroviral Agents Type of study: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: En Journal: J Acquir Immune Defic Syndr Journal subject: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Year: 2015 Document type: Article Affiliation country: Thailand Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: HIV Infections / Anti-Retroviral Agents Type of study: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: En Journal: J Acquir Immune Defic Syndr Journal subject: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Year: 2015 Document type: Article Affiliation country: Thailand Country of publication: United States