Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

Abstract

The scale-up of antiretroviral therapy (ART) has led to a substantial change in the clinical population of HIV-positive patients receiving care. We describe the temporal trends in the demographic and clinical characteristics of HIV-positive patients initiating ART in 2003–13 within an Asian regional cohort. All HIV-positive adult patients that initiated ART between 2003 and 2013 were included. We summarized ART regimen use, age, CD4 cell count, HIV viral load, and HIV-related laboratory monitoring rates during follow-up by calendar year. A total of 16 962 patients were included in the analysis. Patients in active follow-up increased from 695 patients at four sites in 2003 to 11,137 patients at eight sites in 2013. The proportion of patients receiving their second or third ART regimen increased over time (5% in 2003 to 29% in 2013) along with patients aged ≥50 years (8% in 2003 to 18% in 2013). Concurrently, CD4 monitoring has remained stable in recent years, whereas HIV viral load monitoring, although varied among the sites, is increasing. There have been substantial changes in the clinical and demographic characteristics of HIV-positive patients receiving ART in Asia. HIV programmes will need to anticipate the clinical care needs for their aging populations, expanded viral load monitoring, and, the eventual increase in second and third ART regimens that will lead to higher costs and more complex drug procurement needs.

Antiretroviral Long-Term Efficacy and Resistance of Lopinavir/Ritonavir Plus Lamivudine in HIV-1-Infected Treatment-Naïve Patients (ALTERLL): 144-Week Results of a Randomized, Open-Label, Non-Inferiority Study From Guangdong, China

“…Secondary endpoints included the change in CD4 + cell count and ratio of CD4 + and CD8 + , resistance profile, adverse events, and changes in chronic immune activation indicators. If patients in the DT group developed virological failure, they were switched to receive TT on the basis of the national free ART directory ( De La Mata et al, 2017 ; Ning et al, 2017 ).…”

“…In China, the government currently provides free ART for Chinese HIV-infected patients, with treatment comprising a first-line regimen of tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC) plus efavirenz (EFV), and a second-line regimen of lopinavir/ritonavir (LPV/r) plus two nucleoside reverse transcriptase inhibitors (NRTIs) ( Ning et al, 2017 ). However, in patients with a contraindication for TDF and could not obtain other NRTI alternatives, TDF-free simplified therapy, a potentially important alternative, holds several advantages, including low drug toxicity, lower pill burden, better adherence, and increased drug reserves in the future ( Ahamed et al, 2016 ; Chwiki et al, 2017 ; De La Mata et al, 2017 ).…”