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. 2018;23(2):167-178.
doi: 10.3851/IMP3194.

Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE)

Rosario Martinez-Vega  1 , Nicole L De La Mata  2   3 , Nagalingeswaran Kumarasamy  4 , Penh Sun Ly  5 , Kinh Van Nguyen  6 , Tuti P Merati  7 , Thi Thanh Pham  8 , Man Po Lee  9 , Jun Yong Choi  10 , Jeremy L Ross  11 , Oon Tek Ng  1
Affiliations

Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE)

Rosario Martinez-Vega et al. Antivir Ther. 2018.

Abstract

Background: The durability of first-line regimen is important to achieve long-term treatment success for the management of HIV infection. Our analysis describes the duration of sequential ART regimens and identifies the determinants leading to treatment change in HIV-positive patients initiating in Asia.

Methods: All HIV-positive adult patients initiating first-line ART in 2003-2013, from eight clinical sites among seven countries in Asia. Patient follow-up was to May 2014. Kaplan-Meier curves were used to estimate the time to second-line ART and third-line ART regimen. Factors associated with treatment durability were assessed using Cox proportional hazards model.

Results: A total of 16,962 patients initiated first-line ART. Of these, 4,336 patients initiated second-line ART over 38,798 person-years (pys), a crude rate of 11.2 (95% CI 10.8, 11.5) per 100 pys. The probability of being on first-line ART increased from 83.7% (95% CI 82.1, 85.1%) in 2003-2005 to 87.9% (95% CI 87.1, 88.6%) in 2010-2013. Third-line ART was initiated by 1,135 patients over 8,078 pys, a crude rate of 14.0 (95% CI 13.3, 14.9) per 100 pys. The probability of continuing second-line ART significantly increased from 64.9% (95% CI 58.5, 70.6%) in 2003-2005 to 86.2% (95% CI 84.7, 87.6%) in 2010-2013.

Conclusions: Rates of discontinuation of first- and second-line regimens have decreased over the last decade in Asia. Subsequent regimens were of shorter duration compared to the first-line regimen initiated in the same year period. Lower CD4+ T-cell count and the use of suboptimal regimens were important factors associated with higher risk of treatment switch.

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Conflict of interest statement

Disclosure statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Figures

Figure 1
Figure 1. Proportion of patients initiating in each drug class, by year of ART initiation
(A) First-line regimen (drugs initiated in other drug class for first-line regimen included: raltegravir [0.4% overall]; clinical trial drug [<0.1%]). (B) Second-line regimen (drugs initiated in other drug class for second regimen included: raltegravir [3.9%]; clinical trial drug [1.8%]). (C) Third-line regimen (drugs initiated in other drug class for third regimen included: raltegravir [8.5%]; cobicistat [0.5%]; elvitegravir [0.5%]; clinical trial drug [3.8%]). NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
Figure 2
Figure 2. Proportion of patients initiating ARV drugs within each drug class for first-, second- and third-line regimen, by year of ART initiation
(A) Nucleoside reverse transcriptase inhibitor (NRTI) drug combinations (other NRTI drugs initiated included: abacavir or abacavir +3TC/FTC [first-line regimen: 2.8% overall; second-line regimen: 5.4%; third-line regimen: 7.4%]; didanosine or didanosine +3TC/FTC [first-line regimen: 1.0%; second-line regimen: 4.9%; third-line regimen: 5.4%]; stavudine [first-line regimen: 0.1%; second-line regimen: 0.4%; third-line regimen: 0.8%]; zalcitabine [first-line regimen: <0.1%]; zidovudine [first-line regimen: 0.1%; second-line regimen: 1.1%; third-line regimen: 1.2%]; tenofovir [first-line regimen: <0.1%; second-line regimen: 1.2%; third-line regimen: 2.0%]; adefovir [second-line regimen: <0.1%]). (B) Non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs (not represented NNRTI drugs initiated included: DPC 083 [first-line regimen: <0.1%; second-line regimen: <0.1%]; etravirine [first-line regimen: <0.1%; third-line regimen: 0.4%]; rilpivirine [first-line regimen: <0.1%; second-line regimen: 0.1%; third-line regimen: 0.4%]). (C) Protease inhibitor (PI) drugs (other PI drugs initiated included: nelfinavir [first-line regimen: 1.6%; second-line regimen: 0.7%; third-line regimen: 0.9%]; ritonavir [first-line regimen: 0.4%; second-line regimen: 0.2%; third-line regimen: 0.2%]; saquinavir [first-line regimen: 1.8%; second-line regimen 1.5%; third-line regimen: 0.9%]; darunavir [first-line regimen: 3.2%; second-line regimen: 1.4%; third-line regimen: 3.3%]; amprenavir [second-line regimen: <0.1%; third-line regimen: 0.2%]). ATV, atazanavir/ritonavir; AZT, zidovudine; d4T, stavudine; EFV, efavirenz; IDV, indinavir; LPV, lopinavir/ritonavir; NVP, nevirapine; TDF, tenofovir; 3TC/FTC, lamivudine/emtricitabine.
Figure 3
Figure 3. Treatment durability or time to treatment switch for all countries, by year of ART initiation
(A) Time to second-line regimen from first-line regimen initiation. (B) Time to third-line regimen from second regimen initiation. ART, antiretroviral therapy. aLog rank test for trend.
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