High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.
High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.
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DOI：
10.1371/journal.pone.0171780
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Oo HN
中科院分区：
文献类型：
--
作者：
Kyaw NT;Harries AD;Kumar AM;Oo MM;Kyaw KW;Win T;Aung TK;Min AC;Oo HN
近年来，缅甸接受抗逆转录病毒治疗的艾滋病毒感染者人数迅速增加。本研究旨在估计一线ART的病毒学失败率和因HIV综合护理计划（IHC）治疗失败而转为二线ART的病毒学失败率。回顾性分析了2005年至2015年期间在IHC接受一线ART治疗的所有青少年和成人艾滋病毒感染者的数据。估计了一线抗逆转录病毒治疗失败和转为二线抗逆转录病毒治疗的累积风险。使用考克斯回归模型计算粗风险比和校正风险比，以确定与两种结局相关的风险因素。在23，248名成人和青少年中，有7，888人（34%）接受了艾滋病毒载量检测。受试者中病毒学失败的发生率为每100人年随访3.2例，所有患者中转换为二线ART的发生率为每100人年随访1.4例。与病毒学失败相关的因素包括：青少年;至少失访一次;在ART开始时有WHO 3期和4期;在来IHC之前在其他地方接受过一线ART。在1032例符合病毒学失败标准的患者中，762例（74%）转为二线ART治疗。我们发现队列中三分之一接受病毒载量检测的患者病毒学失败率很高。在一线抗逆转录病毒治疗病毒学失败的患者中，约四分之一没有转为二线抗逆转录病毒治疗。在这种情况下，应考虑进行常规病毒载量监测，特别是那些被确定为具有较高治疗失败风险的患者，以检测所有一线抗逆转录病毒治疗失败的患者。还需要制定策略，以防止治疗失败，并治疗更多实际失败的患者。
The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing.