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Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD
Author(s) -
Jiamsakul Awachana,
Kerr Stephen J.,
Ng Oon Tek,
Lee Man Po,
Chaiwarith Romanee,
Yunihastuti Evy,
Van Nguyen Kinh,
Pham Thuy Thanh,
Kiertiburanakul Sasisopin,
Ditangco Rossana,
Saphonn Vonthanak,
Sim Benedict L. H.,
Merati Tuti Parwati,
Wong Wingwai,
Kantipong Pacharee,
Zhang Fujie,
Choi Jun Yong,
Pujari Sanjay,
Kamarulzaman Adeeba,
Oka Shinichi,
Mustafa Mahiran,
Ratanasuwan Winai,
Petersen Boondarika,
Law Matthew,
Kumarasamy Nagalingeswaran
Publication year - 2016
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12690
Subject(s) - cart , medicine , adverse effect , human immunodeficiency virus (hiv) , antiretroviral therapy , viral load , immunology , mechanical engineering , engineering
Objectives Treatment interruptions ( TI s) of combination antiretroviral therapy ( cART ) are known to lead to unfavourable treatment outcomes but do still occur in resource‐limited settings. We investigated the effects of TI associated with adverse events ( AE s) and non‐ AE ‐related reasons, including their durations, on treatment failure after cART resumption in HIV ‐infected individuals in Asia. Methods Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TI s due to AE s and 135 (3.0%) had TI s for other reasons. Median interruption times were 22 days for AE and 148 days for non‐ AE TI s. In multivariable analyses, interruptions >30 days were associated with failure (31–180 days HR = 2.66, 95% CI (1.70–4.16); 181–365 days HR = 6.22, 95% CI (3.26–11.86); and >365 days HR = 9.10, 95% CI (4.27–19.38), all P < 0.001, compared to 0–14 days). Reasons for previous TI were not statistically significant ( P = 0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption.