Gonzalez-Serna Alejandro, Chan Keith, Yip Benita, Chau William, McGovern Rachel, Samji Hasina, Lima Viviane Dias, Hogg Robert S, Harrigan Richard
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
J Antimicrob Chemother. 2014 Aug;69(8):2202-9. doi: 10.1093/jac/dku112. Epub 2014 Apr 15.
The aim of this study was to describe the rates and predictors of discontinuing first-line antiretroviral therapy in the different eras of treatment over a nearly 20 year period initiated in British Columbia between 1992 and 2010.
All naive adults who started antiretroviral therapy (first-line antiretroviral therapy) at any hospital or clinic in British Columbia (Canada) in 1992-2010 were included in this population-based retrospective cohort study. We were primarily interested in whether the era of treatment (1992-95, 1996-2000, 2001-05 and 2006-10) was associated with discontinuation (stopping or switching of initial treatment) within 3 years of starting therapy. Weibull survival analysis was used to model the era of treatment and its association with time to discontinuation.
The study included 7901 patients. Overall, the probability of discontinuing at 12, 24 and 36 months of treatment was 52%, 68% and 76%, respectively. In the adjusted model, variables associated with discontinuing were earlier treatment era, younger age, low adherence and lower baseline CD4 count. Regarding the 2006-10 period, the probability of discontinuing at 12, 24 and 36 months was 36%, 47% and 53%, respectively. In the adjusted model, the variables associated with discontinuation were younger age, female gender, AIDS-defining illnesses at baseline, low adherence and a protease inhibitor (PI)-based regimen.
Discontinuation rates of first-line therapy have decreased over time, but are still quite high even for the latest drug combinations. In the most recent era, younger women on a PI regimen and those not achieving optimal adherence had the highest risk of discontinuing first-line antiretroviral therapy.
本研究旨在描述1992年至2010年在不列颠哥伦比亚省启动的近20年不同治疗时代中一线抗逆转录病毒治疗停药的发生率及预测因素。
本基于人群的回顾性队列研究纳入了1992年至2010年期间在加拿大不列颠哥伦比亚省任何医院或诊所开始抗逆转录病毒治疗（一线抗逆转录病毒治疗）的所有初治成人。我们主要关注治疗时代（1992 - 95年、1996 - 2000年、2001 - 05年和2006 - 10年）是否与开始治疗后3年内停药（停止或更换初始治疗）相关。采用威布尔生存分析对治疗时代及其与停药时间的关联进行建模。
该研究纳入了7901例患者。总体而言，治疗12个月、24个月和36个月时停药的概率分别为52%、68%和76%。在调整模型中，与停药相关的变量有治疗时代较早、年龄较小、依从性低和基线CD4计数较低。对于2006 - 10年期间，治疗12个月、24个月和36个月时停药的概率分别为36%、47%和53%。在调整模型中，与停药相关的变量有年龄较小、女性、基线时患有艾滋病界定疾病、依从性低和基于蛋白酶抑制剂（PI）的治疗方案。
一线治疗的停药率随时间有所下降，但即使对于最新的药物组合，停药率仍然相当高。在最近的时代，接受PI治疗方案的年轻女性以及那些未达到最佳依从性的患者一线抗逆转录病毒治疗停药风险最高。
