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Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries.
McMahon, James H; Spelman, Tim; Ford, Nathan; Greig, Jane; Mesic, Anita; Ssonko, Charles; Casas, Esther C; O'Brien, Daniel P.
Afiliação
  • McMahon JH; Infectious Diseases, Monash University and Alfred Hospital, Melbourne, Australia ; Burnet Institute, Centre for Population Health, Melbourne, Australia.
  • Spelman T; Burnet Institute, Centre for Population Health, Melbourne, Australia.
  • Ford N; Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa ; Division of Infectious Diseases, Imperial College London, London, UK.
  • Greig J; Manson Unit, Médecins Sans Frontières, London, UK.
  • Mesic A; Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands.
  • Ssonko C; Manson Unit, Médecins Sans Frontières, London, UK.
  • Casas EC; Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands.
  • O'Brien DP; Manson Unit, Médecins Sans Frontières, London, UK ; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
AIDS Res Ther ; 13: 25, 2016.
Article em En | MEDLINE | ID: mdl-27408611
BACKGROUND: Antiretroviral therapy (ART) treatment interruptions lead to poor clinical outcomes with unplanned or unstructured TIs (uTIs) likely to be underreported. This study describes; uTIs, their risk factors and association with survival. METHODS: Analysis of ART programmatic data from 11 countries across Asia and Africa between 2003 and 2013 where an uTI was defined as a ≥90-day patient initiated break from ART calculated from the last day the previous ART prescription would have run out until the date of the next ART prescription. Factors predicting uTI were assessed with a conditional risk-set multiple failure time-to-event model to account for repeated events per subject. Association between uTI and mortality was assessed using Cox proportional hazards, with a competing risks extension to test for the influence of lost to follow-up (LTFU). RESULTS: 40,632 patients were included from 11 countries across 33 sites (17 Africa, 16 Asia). Median duration of follow-up was 1.61 years (IQR 0.54-3.31 years), 3386 (8.3 %) patients died, and 3453 (8.5 %) were LTFU. There were 14,817 uTIs, with 10,162 (25 %) patients having more than one uTI. In the adjusted model males were at lower risk of uTI (aHR 0.94, p < 0.01, and age 20-59 was protective compared to <20 years (20-39 years aHR 0.87, p < 0.01; 40-59 years aHR 0.86, p < 0.01). Preserved immune function, as measured by higher CD4 cell count, was associated with a reduced rate of uTI compared to CD4 <200 cells/µL (CD4 200-350 cells/µL aHR 0.89, p < 0.01; CD4 >350 cells/µL aHR 0.87, p < 0.01), whereas advanced clinical disease was associated with increased uTI rate (WHO stage 3 aHR 1.10, p < 0.01; WHO stage 4 aHR 1.21, p < 0.01). There was no relationship between uTI and mortality after adjusting for disease status and considering LTFU as a competing risk. CONCLUSIONS: uTIs were frequent in people in ART programs in low-middle income countries and associated with younger age, female gender and advanced HIV. uTI did not predict survival when loss to follow-up was considered a competing risk. Further evaluation of uTI predictors and interventions to reduce their occurrence is warranted.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV / Adesão à Medicação Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Africa / Asia Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV / Adesão à Medicação Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Africa / Asia Idioma: En Ano de publicação: 2016 Tipo de documento: Article