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Trends in First-Line Antiretroviral Therapy in Asia: Results from the TREAT Asia HIV Observational Database

Authors
 David Charles Boettiger  ;  Stephen Kerr  ;  Rossana Ditangco  ;  Tuti Parwati Merati  ;  Thuy Thi Thanh Pham  ;  Romanee Chaiwarith  ;  Sasisopin Kiertiburanakul  ;  Chung Ki Patrick Li  ;  Nagalingeswaran Kumarasamy  ;  Saphonn Vonthanak  ;  Christopher Lee  ;  Nguyen Van Kinh  ;  Sanjay Pujari  ;  Wing Wai Wong  ;  Adeeba Kamarulzaman  ;  Fujie Zhang  ;  Evy Yunihastuti  ;  Jun Yong Choi  ;  Shinichi Oka  ;  Oon Tek Ng  ;  Pacharee Kantipong  ;  Mahiran Mustafa  ;  Winai Ratanasuwan  ;  Annette Sohn  ;  Matthew Law 
Citation
 PLOS ONE, Vol.9(9) : e106525, 2014 
Journal Title
PLOS ONE
Issue Date
2014
MeSH
Adult ; Anti-HIV Agents/therapeutic use ; Antiretroviral Therapy, Highly Active/adverse effects ; Antiretroviral Therapy, Highly Active/methods* ; Asia ; Dideoxynucleosides/therapeutic use ; Drug-Related Side Effects and Adverse Reactions/classification ; Drug-Related Side Effects and Adverse Reactions/pathology* ; Female ; HIV/drug effects ; HIV Infections/drug therapy* ; HIV Infections/pathology ; HIV Infections/virology ; Humans ; Male ; Nevirapine/therapeutic use ; Reverse Transcriptase Inhibitors/therapeutic use* ; Stavudine/therapeutic use
Abstract
Background : Antiretroviral therapy (ART) has evolved rapidly since its beginnings. This analysis describes trends in first-line ART use in Asia and their impact on treatment outcomes.

Methods : Patients in the TREAT Asia HIV Observational Database receiving first-line ART for ≥6 months were included. Predictors of treatment failure and treatment modification were assessed.

Results : Data from 4662 eligible patients was analysed. Patients started ART in 2003–2006 (n = 1419), 2007–2010 (n = 2690) and 2011–2013 (n = 553). During the observation period, tenofovir, zidovudine and abacavir use largely replaced stavudine. Stavudine was prescribed to 5.8% of ART starters in 2012/13. Efavirenz use increased at the expense of nevirapine, although both continue to be used extensively (47.5% and 34.5% of patients in 2012/13, respectively). Protease inhibitor use dropped after 2004. The rate of treatment failure or modification declined over time (22.1 [95%CI 20.7–23.5] events per 100 patient/years in 2003–2006, 15.8 [14.9–16.8] in 2007–2010, and 11.6 [9.4–14.2] in 2011–2013). Adjustment for ART regimen had little impact on the temporal decline in treatment failure rates but substantially attenuated the temporal decline in rates of modification due to adverse event. In the final multivariate model, treatment modification due to adverse event was significantly predicted by earlier period of ART initiation (hazard ratio 0.52 [95%CI 0.33–0.81], p = 0.004 for 2011–2013 versus 2003–2006), older age (1.56 [1.19–2.04], p = 0.001 for ≥50 years versus <30years), female sex (1.29 [1.11–1.50], p = 0.001 versus male), positive hepatitis C status (1.33 [1.06–1.66], p = 0.013 versus negative), and ART regimen (11.36 [6.28–20.54], p<0.001 for stavudine-based regimens versus tenofovir-based).

Conclusions : The observed trends in first-line ART use in Asia reflect changes in drug availability, global treatment recommendations and prescriber preferences over the past decade. These changes have contributed to a declining rate of treatment modification due to adverse event, but not to reductions in treatment failure.
Files in This Item:
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DOI
10.1371/journal.pone.0106525
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100290
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