Publication: Treatment modification after second-line failure among people living with HIV in Asia-Pacific
Issued Date
2021-04-12
Resource Type
ISSN
20402058
13596535
13596535
DOI
Other identifier(s)
2-s2.0-85106544855
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Mahidol University
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SCOPUS
Bibliographic Citation
Antiviral Therapy. Vol.25, No.7 (2021), 377-387
Suggested Citation
Awachana Jiamsakul, Iskandar Azwa, Fujie Zhang, Evy Yunihastuti, Rossana Ditangco, Nagalingeswaran Kumarasamy, Oon Tek Ng, Yu Jiun Chan, Penh Sun Ly, Jun Yong Choi, Man Po Lee, Sanjay Pujari, Sasisopin Kiertiburanakul, Romanee Chaiwarith, Tuti Parwati Merati, Shashikala Sangle, Suwimon Khusuwan, Benedict L.H. Sim, Anchalee Avihingsanon, Cuong Duy Do, Junko Tanuma, Jeremy Ross, Matthew Law Treatment modification after second-line failure among people living with HIV in Asia-Pacific. Antiviral Therapy. Vol.25, No.7 (2021), 377-387. doi:10.3851/IMP3388 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78278
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Title
Treatment modification after second-line failure among people living with HIV in Asia-Pacific
Author(s)
Awachana Jiamsakul
Iskandar Azwa
Fujie Zhang
Evy Yunihastuti
Rossana Ditangco
Nagalingeswaran Kumarasamy
Oon Tek Ng
Yu Jiun Chan
Penh Sun Ly
Jun Yong Choi
Man Po Lee
Sanjay Pujari
Sasisopin Kiertiburanakul
Romanee Chaiwarith
Tuti Parwati Merati
Shashikala Sangle
Suwimon Khusuwan
Benedict L.H. Sim
Anchalee Avihingsanon
Cuong Duy Do
Junko Tanuma
Jeremy Ross
Matthew Law
Iskandar Azwa
Fujie Zhang
Evy Yunihastuti
Rossana Ditangco
Nagalingeswaran Kumarasamy
Oon Tek Ng
Yu Jiun Chan
Penh Sun Ly
Jun Yong Choi
Man Po Lee
Sanjay Pujari
Sasisopin Kiertiburanakul
Romanee Chaiwarith
Tuti Parwati Merati
Shashikala Sangle
Suwimon Khusuwan
Benedict L.H. Sim
Anchalee Avihingsanon
Cuong Duy Do
Junko Tanuma
Jeremy Ross
Matthew Law
Other Contributor(s)
The Voluntary Health Services, Chennai
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
Gokila
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
The Kirby Institute
National Center for Global Health and Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
Sassoon General Hospital
University of Health Sciences
Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Research Institute for Health Sciences
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
Gokila
Bach Mai Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
The Kirby Institute
National Center for Global Health and Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
Sassoon General Hospital
University of Health Sciences
Foundation for AIDS Research
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Research Institute for Health Sciences
Abstract
Background: The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure. Methods: Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for >14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL <1,000 copies/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression. Results: Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications. Conclusions: CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.