Predictors of Virologic Failure in HIV‐1–Infected Adults Receiving First‐Line Antiretroviral Therapy in 8 Provinces in China

Abstract

Background Despite poor primary healthcare systems, free antiretroviral therapy (ART) has been available in China for over 5 years. Virologic outcomes of Chinese patients receiving ART have not been described at a national level. Methods A multi-stage cluster design was used in 8 provinces to randomly sample patients with at least 6 months on first-line ART, stratified by 3 treatment duration groups. Viral load testing and patient interviews were conducted and linked with national treatment database information. Data collected were analyzed for association with viral suppression using multivariable modeling. Adequate viral suppression was defined as viral load less than 400 copies/mL. Results Of 5,256 patients on ART, 3,894 patients met eligibility criteria from whom 1,153 were analyzed. Overall, 72% demonstrated viral suppression; of these, 82%, 73%, and 67% of participants on ART for 6–11 months, 12–23 months, and ≥24 months, respectively, showed viral suppression (p<0.001). In a multivariable model, treatment received at locations other than county level hospitals was less likely to achieve viral suppression, with greater odds for inadequate virologic response found at village clinics (odds ratio [OR] 5.4; 95% confidence interval [CI], 2.9–10.1), township health centers (OR, 3.1; CI, 1.7–5.6), and public health clinics (OR, 3.1; CI, 1.7–5.6). Patients receiving didanosine-based regimens were more likely to experience an inadequate virologic response than those receiving lamivudine-based regimens (OR, 3.9; CI, 2.7–5.7). Conclusions China’s national ART program is largely successful at suppressing viral load. Care received outside of hospitals and regimens containing didanosine were associated with less favorable virologic outcomes.

Targeting HIV Prevention Based on Molecular Epidemiology Among Deeply Sampled Subnetworks of Men Who Have Sex With Men

“…The prevalence of SDRM remained relatively low and constant across the period of observation compared with transmitted drug resistance (TDR) in the United States and Western Europe [29]. Even though the rate of TDR was low, it is still likely an overestimation, since M46I/L is likely a natural polymorphism for CRF_01AE [30] and would not affect the current Chinese recommended first-line regimens [31,32].…”

“…Although this method seems promising, if resources are not constrained, the best method for both the infected individual and all of their partners is to provide ART to all infected individuals [25]. However, the current Chinese HIV treatment guidelines only allow for individuals with CD4 counts <350 cells/mL to be treated [31,32]. Therefore, we also evaluated CD4 count as a potential target for a prevention intervention and found that providing ART based on low CD4 counts was not any more efficient (<11%) than providing ART to everyone (23%).…”

HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

“…n=z 2 p (1-p)/w2 [21,22] n=minimum sample size, W=estimated error=0.05; P=population proportion in problem (estimated prevalence)=0.5, and Z α/2=1.96 by assuming 95% confidence interval. The minimum sample size was n=384 (by adding 10% non-response rate) 421 participants participated.…”

Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China

“…8 Already, the 10-year-old programme is seeing some success: mortality rates and viral loads have decreased more among enrolled patients than among those not undergoing treatment. [9][10][11][12] Similarly, the National Methadone Maintenance Treatment Programme has reduced drug dependence and involvement in drug-related crime among clients, increased the employment rate and improved social functioning. 6 This programme has helped 357 586 opioid-dependent individuals since 2004; 8 it is, in fact, the largest network for methadone maintenance treatment in the world.…”

“…The lower uptake of ART and the poorer outcomes observed among HIV+ people who inject illicit drugs are thought to be attributable to a variety of factors, such as delays in starting treatment, poor adherence to ART, continuing drug dependence and a high prevalence of comorbidities, such as depression and hepatitis C. 19 Internationally, there is growing evidence that treatment of opioid dependence, such as methadone maintenance treatment (MMT), not only stabilizes drug dependence and its associated psychosocial conditions, but also promotes adherence to ART and improves virological responses among HIV+ people. 18,[20][21][22][23] Although China's national ART and MMT programmes have been shown to benefit their respective target populations when assessed independently, 6,[9][10][11]24,25 the advantages of coincident ART and MMT for HIV+ people who inject opioids have not yet been examined in China, though they have Objective To examine the effect of methadone maintenance treatment (MMT) on mortality in people injecting opioids who receive antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection in China. Methods The study involved a nationwide cohort of 23 813 HIV-positive (HIV+) people injecting opioids who received ART between 31 December 2002 and 31 December 2011.…”