Subronto Yanri Wijayanti, Kusmayanti Nur Aini, Abdalla Albarisa Shobry, Sattwika Prenaly Dwisthi
Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, 55281, Indonesia.
Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
Ann Med Surg (Lond). 2020 Oct 15;60:56-60. doi: 10.1016/j.amsu.2020.10.005. eCollection 2020 Dec.
Indonesia antiretroviral therapy guideline suggests the use of Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based regiments as first line of HIV treatment and Protease Inhibitor to replace NNRTI when treatment failure occurred. This case-control study was aimed to study factors predicting first-line ART treatment failure among HIV positive patients aged >15 years, non-pregnant, and registered in our institution, Indonesia.
Diagnosis of HIV treatment failure was made according to the standard WHO criteria. Demographic and outcome variables were recorded. The association between variables were analyzed by Chi-square test with odds ratios (OR) and 95% confidence intervals (95% CI), followed by multivariate analysis using logistic regression test.
Twenty-six index cases and 26 age- and sex-matched control cases were included in the study with a mean age of 32.27 ± 8.7 years and 32.88 ± 8.15 years, respectively. Median time for switching to second-line (Lopinavir/ritonavir, LPV/r) was 46.32 ± 30.21 months. Patients presented with tuberculosis and treated by nevirapine as the first-line treatment were 26.6-folds (95% CI: 2.41-293.81, = 0.007) and 6.7-folds (95% CI: 1.56-28.45, = 0.011) higher risk for treatment failure, respectively.
The presence of tuberculosis and the use of nevirapine in first-line treatment were strong predictors for first-line ARV treatment failure, suggesting for closer clinical monitoring for patients with those conditions. A further and larger prospective cohort study is needed to confirm the findings in this study.
印度尼西亚抗逆转录病毒治疗指南建议使用基于非核苷类逆转录酶抑制剂（NNRTI）的方案作为HIV治疗的一线方案，并在治疗失败时使用蛋白酶抑制剂替代NNRTI。本病例对照研究旨在探讨在印度尼西亚我们机构登记的年龄大于15岁、非妊娠的HIV阳性患者中预测一线抗逆转录病毒治疗失败的因素。
根据世界卫生组织标准诊断HIV治疗失败。记录人口统计学和结局变量。通过卡方检验分析变量之间的关联，并计算比值比（OR）和95%置信区间（95%CI），随后使用逻辑回归检验进行多变量分析。
本研究纳入了26例索引病例和26例年龄及性别匹配的对照病例，平均年龄分别为32.27±8.7岁和32.88±8.15岁。改用二线治疗（洛匹那韦/利托那韦，LPV/r）的中位时间为46.32±30.21个月。一线治疗使用奈韦拉平治疗的结核病患者治疗失败风险分别高26.6倍（95%CI：2.41 - 293.81，P = 0.007）和6.7倍（95%CI：1.56 - 28.45，P = 0.011）。
结核病的存在以及一线治疗中使用奈韦拉平是一线抗逆转录病毒治疗失败的有力预测因素，提示对患有这些疾病的患者进行更密切的临床监测。需要进一步开展更大规模的前瞻性队列研究来证实本研究的结果。
