Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region
Wright, S.; Boyd, M.A.; Yunihastuti, E.; Law, M.; Sirisanthana, T.; Hoy, J.; Pujari, S.; Lee, M.P.; Petoumenos, K.; Ellis, D.; Bloch, M.; Franic, T.; Agrawal, S.; McCann, L.; Cunningham, N.; Vincent, T.; Allen, D.; Little, J.L.; Smith, D.; Gray, C.; Baker, D.; Vale, R.; Templeton, D.J.; O'Connor, C.C.; Dijanosic, C.; Jackson, E.; McCallum, K.; Grotowski, M.; Taylor, S.; Cooper, D.; Carr, A.; Lee, F.; Hesse, K.; Sinn, K.; Norris, R.; Finlayson, R.; Prone, I.; Jackson, E.; Shakeshaft, J.; Bro
Plos one 8(6): E64902
2013
ISSN/ISBN: 1932-6203 PMID: 23840312 DOI: 10.1371/journal.pone.0064902Document Number: 578295
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. 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. 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. 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.