Srasuebkul Preeyaporn, Calmy Alexandra, Zhou Jialun, Kumarasamy Nagalingeswaran, Law Matthew, Lim Poh Lian
The National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, Sydney, NSW, Australia.
St Vincent's Hospital, Sydney, Australia.
AIDS Res Ther. 2007 Sep 17;4:18. doi: 10.1186/1742-6405-4-18.
It is critical to understand the pattern of antiretroviral treatment (ART) prescription in different regions of the world as ART procurement needs to be anticipated. We aimed at exploring rates and predictors of ART combination changes in clinical practice in Treat Asia HIV Observational Database (TAHOD).
Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least one follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen.
A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year. In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category, the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 - 1.96), p < 0.001, RR 3.39 (2.76 - 4.16) p < 0.001, RR 6.37 (4.51 - 9.00), p < 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 - 0.99), p = 0.035, RR 0.77 (0.61 - 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 - 1.51), p < 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 - 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse events were 31, 27 and 32 in 1st, 2nd and 3rd treatment combinations, respectively.
Our study suggests that drug availability impacts on ART prescription patterns. Our data, reflecting real clinic use in Asia, suggest that around half of all patients require second combination ART by 3 years after treatment initiation.
了解世界不同地区的抗逆转录病毒治疗（ART）处方模式至关重要，因为需要提前预估ART的采购需求。我们旨在探索亚洲治疗HIV观察数据库（TAHOD）临床实践中ART组合变化的发生率及预测因素。
对TAHOD中开始一线三联或更多药物ART组合且至少有一次随访的患者的ART变化率进行研究。按随访年份总结ART变化率，并使用随机效应泊松回归评估与变化相关的因素。采用Kaplan-Meier方法确定患者在其第一个、第二个和第三个治疗方案中的持续时间。
共有1846例患者开始使用至少三种药物的ART组合。首次治疗的中位随访时间为3.2年。ART变化的总体发生率为每100人年29次。在单变量分析中，治疗变化率与暴露类别、国家收入类别、药物类别组合、日历年和组合数量显著相关。在多变量分析中，与d4T/3TC/NVP相比，开始使用另一种含NNRTI的方案、仅含PI的方案或三联NRTI方案进行ART治疗与组合变化风险较高相关（相对风险（RR）1.6（95%CI 1.64 - 1.96），p < 0.001；RR 3.39（2.76 - 4.16），p < 0.001；RR 6.37（4.51 - 9.00），p < 0.001）。与首次ART组合相比，处于第二个或第三个组合治疗方案也与ART变化率降低相关（RR 0.82（0.68 - 0.99），p = 0.035；RR 0.77（0.61 - 0.97），p = 0.024）。使用药物少于12种的治疗点治疗变化率增加（1.31（1.13 - 1.51），p < 0.001）。注射吸毒者以及其他/未知暴露被发现会增加治疗变化率（1.24（1.00 - 1.54），p = 0.055）。在第一个、第二个和第三个治疗组合中，因不良事件停止治疗的患者百分比分别为31%、27%和32%。
我们的研究表明药物可及性会影响ART处方模式。我们的数据反映了亚洲的实际临床使用情况，表明约一半的患者在治疗开始3年后需要第二种ART组合。
