Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy-evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011
Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy-evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011
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DOI：
10.11604/pamj.2018.29.191.11940
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发表时间：
2018-04-02
影响因子：
1.2
通讯作者：
Kaleebu, Pontiano
中科院分区：
文献类型：
--
作者：
Kazooba, Patrick;Mayanja, Billy Nsubuga;Kaleebu, Pontiano
我们研究了影响一线抗逆转录病毒治疗（ART）的病毒学失败（VF）的因素，并评估了转向二线抗逆转录病毒治疗的实用方法。方法：2004 - 2011年间，我们对接受ART治疗的成人进行了评估。在接受ART治疗6个月或更长时间后，VL > 1000拷贝/ml或连续两次VL > 400拷贝/ml （Conventional VF）的参与者接受强化依从性咨询，并继续接受一线ART治疗6个多月，之后，VL > 1000拷贝/ml （Pragmatic VF）的参与者切换到二线ART。计算VF率，并通过拟合logistic回归和Cox比例风险模型找到失败的预测因素。结果：316名参与者累积1036人年风险（年），84名（26.6%）患有常规VF（率8.6 / 100年），其中28名（33.3%）患有实际性VF（率2.7 / 100年）。常规VF的独立预测因子为；酒精摄入量（校正风险比，aHR = 1.71, 95% CI 1.05-2.79, P = 0.03）和ART依从性：每减少10%的依从性就诊比例（aHR = 1.83, 95% CI 1.50-2.23, P < 0.001）。以参照年龄组< 30岁为例，在常规失败中，30 ~ 39岁年龄组实用失败的校正优势比（aOR）为0.12,95% CI 0.03 ~ 0.57, P = 0.02； 50 ~ 40岁年龄组实用失败的校正优势比（aOR）为0.14,95% CI 0.03 ~ 0.71, P = 0.02。酒精消费者比非酒精消费者有三倍的实际失败几率（aOR = 3.14, 95% CI 0.95-10.34, P = 0.06）。结论：实用的VF方法是指导转入二线抗逆转录病毒治疗的关键。建议在年轻患者和酗酒者中为患者量身定制抗逆转录病毒治疗依从性咨询。
Introduction: We investigated factors affecting Virological failure (VF) on first line Antiretroviral Therapy (ART) and evaluated a pragmatic approach to switching to second line ART. Methods: Between 2004 and 2011, we assessed adults taking ART. After 6 months or more on ART, participants with VL > 1000 copies/ml or two successive VL > 400 copies/ml (Conventional VF) received intensified adherence counselling and continued on first-line ART for 6 more months, after which participants who still had VL > 1000 copies/ml (Pragmatic VF) were switched to second line ART. VF rates were calculated and predictors of failure were found by fitting logistic regression and Cox proportional hazards models. Results: The 316 participants accrued 1036 person years at risk (pyar), 84 (26.6%) had conventional VF (rate 8.6 per 100 pyar) of whom 28 (33.3%) had pragmatic VF (rate 2.7 per 100 pyar). Independent predictors of conventional VF were; alcohol consumption, (adjusted Hazard Ratio; aHR = 1.71, 95% CI 1.05-2.79, P = 0.03) and ART adherence: per 10% decrease in proportion of adherent visits, (aHR = 1.83, 95% CI 1.50-2.23; P < 0.001). Using reference age group < 30 years, among conventional failures, the adjusted odds ratio (aOR) of pragmatic failure for age group 30-39 years were 0.12, 95% CI 0.03-0.57, P = 0.02 and for age group > 40 years were 0.14, 95% CI 0.03-0.71, P = 0.02. Alcohol consumers had a threefold odds of pragmatic failure than non-alcohol consumers (aOR = 3.14, 95% CI 0.95-10.34, P = 0.06). Conclusion: A pragmatic VF approach is essential to guide switching to second line ART. Patient tailored ART adherence counselling among young patients and alcohol users is recommended.