Publication: Survival after long-term ART exposure: Findings from an Asian patient population retained in care beyond 5 years on ART
Issued Date
2021-01-01
Resource Type
ISSN
20402058
13596535
13596535
DOI
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2-s2.0-85098463524
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Mahidol University
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SCOPUS
Bibliographic Citation
Antiviral Therapy. Vol.25, No.3 (2021), 131-142
Suggested Citation
Rimke Bijker, Sasisopin Kiertiburanakul, Nagalingeswaran Kumarasamy, Sanjay Pujari, Ly P. Sun, Oon T. Ng, Man P. Lee, Jun Y. Choi, Kinh V. Nguyen, Yu J. Chan, Tuti P. Merati, Do D. Cuong, Jeremy Ross, Awachana Jiamsakul Survival after long-term ART exposure: Findings from an Asian patient population retained in care beyond 5 years on ART. Antiviral Therapy. Vol.25, No.3 (2021), 131-142. doi:10.3851/IMP3358 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78868
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Title
Survival after long-term ART exposure: Findings from an Asian patient population retained in care beyond 5 years on ART
Other Contributor(s)
VHS Medical Centre India
Bach Mai Hospital
Universitas Udayana
The Kirby Institute
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
University of Health Sciences
National Hospital for Tropical Diseases
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Bach Mai Hospital
Universitas Udayana
The Kirby Institute
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
Veterans General Hospital-Taipei
Tan Tock Seng Hospital
University of Health Sciences
National Hospital for Tropical Diseases
amfAR - The Foundation for AIDS Research
Institute of Infectious Diseases
Abstract
Background: This study investigated survival in people living with HIV being followed-up from 5 and 10 years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort. Methods: We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond 5 and 10 years on ART were analysed using competing risk regression with time-updated variables. Results: Of 13,495 patients retained after 5 years on ART, 279 subsequently died (0.56/100 person-years). Increased mortality was associated with age >50 years (sub-hazard ratio [sHR] 2.24, 95% CI 1.58, 3.15, compared with ≤40 years), HIV exposure through injecting drug use (sHR 2.17, 95% CI 1.32, 3.56), HIV viral load ≥1,000 copies/ml: sHR 1.52, 95% CI 1.05, 2.21, compared with <400), regimen (second-line regimen: sHR 2.11, 95% CI 1.52, 2.94, and third-line regimen: sHR 2.82, 95% CI 2.00, 3.98, compared with first-line regimen), HBV coinfection (sHR 2.23, 95% CI 1.49, 3.33), fasting plasma glucose ≥126 mg/dl (sHR 1.98, 95% CI 1.22, 3.21, compared with <100 mg/dl) and estimated glomerular filtration rate <60 ml/min/1.73 m2 (sHR 2.57, 95% CI 1.56, 4.22). Decreased mortality was associated with transmission through male-to-male sexual contact (sHR 0.44, 95% CI 0.22, 0.88, compared with heterosexual transmission) and higher CD4+ T-cell count (200-349 cells/µl: sHR 0.27, 95% CI 0.20, 0.38, 350-499 cells/µl: sHR 0.10, 95% CI 0.07, 0.16 and ≥500 cells/µl: sHR 0.09, 95% CI 0.06, 0.13, compared with <200 cells/µl). Results after 10 years were similar, but most associations were weaker due to limited power. Conclusions: Next to preventing ART failure, HIV programmes should carefully monitor and treat comorbidities, including hepatitis, kidney disease and diabetes, to optimize survival after long-term ART exposure.
