Treatment modification after second-line failure among people living with HIV in Asia-Pacific

the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

doi:10.3851/IMP3388

Treatment modification after second-line failure among people living with HIV in Asia-Pacific

the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.

Original language	English
Pages (from-to)	377-387
Number of pages	11
Journal	Antiviral therapy
Volume	25
Issue number	7
DOIs	https://doi.org/10.3851/IMP3388
Publication status	Published - 2021 Apr 12

Bibliographical note

Funding Information:
The TREAT Asia HIV Observational Database and The TREAT Asia HIV Observational Database Low-Intensity TransfEr are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. A list of the site investigators and study teams can be found in Additional file 1.

Publisher Copyright:
© 2020 International Medical Press

All Science Journal Classification (ASJC) codes

Pharmacology
Pharmacology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3851/IMP3388

Cite this

@article{22843ee10fef4dd68b660d1febed5ca8,

title = "Treatment modification after second-line failure among people living with HIV in Asia-Pacific",

abstract = "Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.",

author = "{the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific} and Awachana Jiamsakul and Iskandar Azwa and Fujie Zhang and Evy Yunihastuti and Rossana Ditangco and Nagalingeswaran Kumarasamy and Ng, {Oon Tek} and Chan, {Yu Jiun} and Ly, {Penh Sun} and Choi, {Jun Yong} and Lee, {Man Po} and Sanjay Pujari and Sasisopin Kiertiburanakul and Romanee Chaiwarith and Merati, {Tuti Parwati} and Shashikala Sangle and Suwimon Khusuwan and Sim, {Benedict L.H.} and Anchalee Avihingsanon and Do, {Cuong Duy} and Junko Tanuma and Jeremy Ross and Matthew Law",

note = "Funding Information: The TREAT Asia HIV Observational Database and The TREAT Asia HIV Observational Database Low-Intensity TransfEr are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health{\textquoteright}s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. A list of the site investigators and study teams can be found in Additional file 1. Publisher Copyright: {\textcopyright} 2020 International Medical Press",

year = "2021",

month = apr,

day = "12",

doi = "10.3851/IMP3388",

language = "English",

volume = "25",

pages = "377--387",

journal = "Antiviral therapy",

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TY - JOUR

T1 - Treatment modification after second-line failure among people living with HIV in Asia-Pacific

AU - the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific

AU - Jiamsakul, Awachana

AU - Azwa, Iskandar

AU - Zhang, Fujie

AU - Yunihastuti, Evy

AU - Ditangco, Rossana

AU - Kumarasamy, Nagalingeswaran

AU - Ng, Oon Tek

AU - Chan, Yu Jiun

AU - Ly, Penh Sun

AU - Choi, Jun Yong

AU - Lee, Man Po

AU - Pujari, Sanjay

AU - Kiertiburanakul, Sasisopin

AU - Chaiwarith, Romanee

AU - Merati, Tuti Parwati

AU - Sangle, Shashikala

AU - Khusuwan, Suwimon

AU - Sim, Benedict L.H.

AU - Avihingsanon, Anchalee

AU - Do, Cuong Duy

AU - Tanuma, Junko

AU - Ross, Jeremy

AU - Law, Matthew

N1 - Funding Information: The TREAT Asia HIV Observational Database and The TREAT Asia HIV Observational Database Low-Intensity TransfEr are initiatives of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Fogarty International Center, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above. A list of the site investigators and study teams can be found in Additional file 1. Publisher Copyright: © 2020 International Medical Press

PY - 2021/4/12

Y1 - 2021/4/12

N2 - Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.

AB - Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.

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ER -

Treatment modification after second-line failure among people living with HIV in Asia-Pacific

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

UN SDGs

Access to Document

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