Kyaw Nang Thu Thu, Harries Anthony D, Kumar Ajay M V, Oo Myo Minn, Kyaw Khine Wut Yee, Win Than, Aung Thet Ko, Min Aung Chan, Oo Htun Nyunt
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
International Union against Tuberculosis and Lung Disease, Paris, France.
PLoS One. 2017 Feb 9;12(2):e0171780. doi: 10.1371/journal.pone.0171780. eCollection 2017.
The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC).
Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes.
Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART.
We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing.
近年来，缅甸接受抗逆转录病毒治疗（ART）的艾滋病毒感染者人数迅速增加。本研究旨在估计综合艾滋病毒护理项目（IHC）中一线ART的病毒学失败率以及因治疗失败而改用二线ART的比例。
回顾性分析了2005年至2015年间在IHC开始接受一线ART治疗的所有艾滋病毒感染青少年和成人患者的常规收集数据。估计了一线ART的病毒学失败和改用二线ART的累积风险。使用Cox回归模型计算粗风险比和调整后的风险比，以确定与这两个结果相关的风险因素。
在23248名成人和青少年中，7888人（34%）接受了艾滋病毒病毒载量检测。检测者中病毒学失败的发病率为每100人年随访3.2例，所有患者中改用二线ART的比例为每100人年随访1.4例。与病毒学失败相关的因素包括：青少年；至少失访一次；在开始ART时处于世界卫生组织3期和4期；在来到IHC之前曾在其他地方接受过一线ART治疗。在符合病毒学失败标准的1032名患者中，762人（74%）改用了二线ART。
我们发现，在接受病毒载量检测的队列中，三分之一的患者病毒学失败率很高。在一线ART病毒学失败的患者中，约四分之一未改用二线ART。在这种情况下，应考虑进行常规病毒载量监测，尤其是对那些被确定为治疗失败风险较高的患者，以检测所有一线ART治疗失败的患者。还需要制定策略来预防治疗失败，并治疗更多实际治疗失败的患者。
