Trends in First-Line Antiretroviral Therapy in Asia: Results from the TREAT Asia HIV Observational Database

Boettiger, David; Kerr, Stephen J.; Ditangco, Rossana; Merati, Tuti Parwati; Pham, Thuy T.; Chaiwarith, Romanee; Kiertiburanakul, Sasisopin; Li, Chung Ki Patrick; Kumarasamy, Nagalingeswaran; Saphonn, Vonthanak; Lee, Christopher; Kính, Nguyễn Văn; Pujari, Sanjay; Wong, Wing Wai; Kamarulzaman, Adeeba; Zhang, Fujie; Yunihastuti, Evy; Choi, Jun Yong; Oka, Shinichi; Ng, Oon Tek; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Sohn, Annette H.; Law, Matthew

doi:10.1371/journal.pone.0106525

Cited by 21 publications

(22 citation statements)

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“…A previous analysis of TAHOD found the common use of PI-based first-line ART in the 90s and early 2000s has been almost entirely displaced by the regional scale up of first-line NNRTI-based therapy. 27 Therefore, it is not surprising that we found a much higher proportion of patients initiated dual NRTI plus NNRTI as second-line before 2007 (36.2%) compared with later time periods (11.6% in 2007-2010, 6.0% after 2010).…”

Section: Discussionmentioning

confidence: 69%

Efficacy of Second-Line Antiretroviral Therapy Among People Living With HIV/AIDS in Asia

Boettiger¹,

Durier³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Roughly 4% of the 1.25 million patients on antiretroviral therapy (ART) in Asia are using second-line therapy. To maximize patient benefit and regional resources it is important to optimize the timing of second-line ART initiation and use the most effective compounds available. Methods HIV positive patients enrolled in the TREAT Asia HIV Observational Database who had used second-line ART for ≥6 months were included. ART use and rates and predictors of second-line treatment failure were evaluated. Results There were 302 eligible patients. Most were male (76.5%) and exposed to HIV via heterosexual contact (71.5%). Median age at second-line initiation was 39.2 years, median CD4 cell count was 146 cells/mm3, and median HIV viral load was 16,224 copies/mL. Patients started second-line ART before 2007 (n=105), 2007-2010 (n=147) and after 2010 (n=50). Ritonavir-boosted lopinavir and atazanavir accounted for the majority of protease inhibitor use after 2006. Median follow-up time on second-line was 2.3 years. The rates of treatment failure and mortality per 100 patient/years were 8.8 (95%CI 7.1 to 10.9) and 1.1 (95%CI 0.6 to 1.9), respectively. Older age, high baseline viral load and use of a protease inhibitor other than lopinavir or atazanavir were associated with a significantly shorter time to second-line failure. Conclusions Increased access to viral load monitoring to facilitate early detection of first-line ART failure and subsequent treatment switch is important for maximizing the durability of second-line therapy in Asia. Although second-line ART is highly effective in the region, the reported rate of failure emphasizes the need for third-line ART in a small portion of patients.

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Section: Discussionmentioning

confidence: 69%

Efficacy of Second-Line Antiretroviral Therapy Among People Living With HIV/AIDS in Asia

Boettiger¹,

Durier³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Combination antiretroviral treatments (cART) have been widely available in Asia since 2003 . However, most Asian HIV clinics have limited resources and are able to prescribe regimens based on WHO global treatment guidelines, which recommend dual nucleoside reverse transcriptase inhibitors (NRTIs) plus a non‐nucleoside reverse transcriptase inhibitor (NNRTI) for first‐line therapy . Current WHO guidelines recommend use of a ritonavir‐boosted protease inhibitor (PI) in combination with dual NRTIs after failure on a first line NNRTI‐based regimen, which is widely practiced in Asia .…”

Section: Introductionmentioning

confidence: 99%

The treatment outcomes of antiretroviral substitutions in routine clinical settings in Asia; data from the TREAT Asia HIV Observational Database (TAHOD)

et al. 2017

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IntroductionAlthough substitutions of antiretroviral regimen are generally safe, most data on substitutions are based on results from clinical trials. The objective of this study was to evaluate the treatment outcomes of substituting antiretroviral regimen in virologically suppressed HIV‐infected patients in non‐clinical trial settings in Asian countries.MethodsThe study population consisted of HIV‐infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD). Individuals were included in this analysis if they started combination antiretroviral treatment (cART) after 2002, were being treated at a centre that documented a median rate of viral load monitoring ≥0.8 tests/patient/year among TAHOD enrolees, and experienced a minor or major treatment substitution while on virally suppressive cART. The primary endpoint to evaluate outcomes was clinical or virological failure (VF), followed by an ART class change. Clinical failure was defined as death or an AIDS diagnosis. VF was defined as confirmed viral load measurements ≥400 copies/mL followed by an ART class change within six months. Minor regimen substitutions were defined as within‐class changes and major regimen substitutions were defined as changes to a drug class. The patterns of substitutions and rate of clinical or VF after substitutions were analyzed.ResultsOf 3994 adults who started ART after 2002, 3119 (78.1%) had at least one period of virological suppression. Among these, 1170 (37.5%) underwent a minor regimen substitution, and 296 (9.5%) underwent a major regimen substitution during suppression. The rates of clinical or VF were 1.48/100 person years (95% CI 1.14 to 1.91) in the minor substitution group, 2.85/100 person years (95% CI 1.88 to 4.33) in the major substitution group and 2.53/100 person years (95% CI 2.20 to 2.92) among patients that did not undergo a treatment substitution.ConclusionsThe rate of clinical or VF was low in both major and minor substitution groups, showing that regimen substitution is generally effective in non‐clinical trial settings in Asian countries.

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“…30,31 Overall, the effects of other adjusted characteristics in the regression models are consistent with previous findings. 4,12,16,32,33 Age and CD4 count were both significantly associated with the three treatment outcomes. Older age showed an association with lower CD4 increase and an increased risk of mortality.…”

Section: Ten Years Of Cart In Tahod 777mentioning

confidence: 93%

“…The initial cART regimen mostly consisted of two nucleoside reverse transcriptase inhibitors (NRTI) and a non-NRTI (NNRTI), with stavudine-and zidovudine-based regimens being the most common. 12 These characteristics are also reported by individual country and can be seen in Supplementary Table S1 (Supplementary Data are available online at www.liebertpub.com/aid).…”

Section: Overall Survivalmentioning

confidence: 99%

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

Jiamsakul¹

2016

AIDS Research and Human Retroviruses

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Asian countries have seen the expansion of combination antiretroviral therapy (cART) over the past decade. The TREAT Asia HIV Observational Database (TAHOD) was established in 2003 comprising 23 urban referral sites in 13 countries across the region. We examined trends in treatment outcomes in patients who initiated cART between 2003 and 2013. Time of cART initiation was grouped into three periods: 2003-2005, 2006-2009, and 2010-2013. We analyzed trends in undetectable viral load (VL; defined as VL <400 copies/ml), CD4 changes from pre-cART levels, and overall survival. Of 6,521 patients included, the overall median CD4 count at cART initiation was 120 cells/ll (interquartile range: 38-218). Despite an increase over time, pre-cART CD4 counts remained <200 cells/ll. Adjusted analyses showed undetectable VL was more likely when starting cART in later years [2006-2009: No differences in CD4 response was observed over time. Age and CD4 levels prior to cART initiation were associated with all three treatment outcomes, with older age and higher CD4 counts being associated with undetectable VL. Survival and VL response on cART have improved over the past decade in TAHOD, although CD4 count at cART initiation remained low. Greater effort should be made to facilitate earlier HIV diagnosis and linkage to care and treatment, to achieve greater improvements in treatment outcomes.

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Trends in First-Line Antiretroviral Therapy in Asia: Results from the TREAT Asia HIV Observational Database

Cited by 21 publications

References 20 publications

Efficacy of Second-Line Antiretroviral Therapy Among People Living With HIV/AIDS in Asia

Efficacy of Second-Line Antiretroviral Therapy Among People Living With HIV/AIDS in Asia

The treatment outcomes of antiretroviral substitutions in routine clinical settings in Asia; data from the TREAT Asia HIV Observational Database (TAHOD)

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

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