Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.
London School of Hygiene and Tropical Medicine, London, UK.
AIDS Res Ther. 2022 Jun 28;19(1):32. doi: 10.1186/s12981-022-00453-4.
There are limited data exploring antiretroviral therapy (ART) changes and time to change among South Africa young people living with HIV/AIDS.
We describe the time to first drug switch, which includes ART regimen change (three drug switch) and substitutions (single drug switch). We describe common reasons for ART switch among young people aged 10 to 24 years in South Africa.
We conducted a retrospective cohort study at a primary health care clinic in Cape Town, South Africa, providing ART to HIV-infected adolescents and adults since 2002. Those aged 10 to 24 years at ART initiation, who accessed care clinic between September 2002 and April 2019. Data was retrieved from electronic information systems: ART regimens, ART changes, dates for initiation or stop of each drug/regimen, laboratory results (viral loads, haemoglobin, liver enzyme results, and creatinine to support the reason for ART switch. From written records, we abstracted reason for single drug switch or regimen change, as well as socio demographic and clinical data. We fitted cox regression models to determine factors associated with ART switch (Having a change in one or more drugs in ART combination) and the rate of occurrence.
Of 2601 adolescents included, 605 (24.9%) adolescents switched ART over 5090.5 person years at risk (PYAR), a rate of 11.9 /100PYAR. Median follow-up time was 4.4 (± 3.2) years. At multivariable analysis, the older age group was protective of the risk of ART switch: adjusted Hazard Ratio [aHR] 0.78, 95% CI 0.62-0.98, transfer status [transferred out 1.42 [1.11-1.82]. The hazard of ART switch increased with more severe HIV-disease at ART start, as observed by increasing WHO clinical stage or reduced CD4 count at baseline. The primary reasons for ART switch were side effects (20.0%), virological failure (17.9%) and formulation switch (27.8%). Others reasons included pregnancy, Hepatitis B, tuberculosis and psychosis.
ART switches are frequent and occur at a consistent rate across 7.5 years from initiation. The main reasons for ART switch were virological failure and drug side effects.
关于南非艾滋病毒感染者接受抗逆转录病毒疗法（ART）后药物改变和改变时间的数据有限。
我们描述了首次药物转换的时间，包括 ART 方案的改变（三种药物转换）和替代（单一药物转换）。我们描述了南非 10 至 24 岁年轻人中常见的 ART 转换原因。
我们在南非开普敦的一家初级保健诊所进行了一项回顾性队列研究，自 2002 年以来一直在为感染艾滋病毒的青少年和成年人提供 ART。那些在开始接受 ART 时年龄为 10 至 24 岁，并在 2002 年 9 月至 2019 年 4 月期间到诊所就诊。数据取自电子信息系统：ART 方案、ART 变化、开始或停止每种药物/方案的日期、实验室结果（病毒载量、血红蛋白、肝酶结果和肌酐以支持 ART 转换的原因。从书面记录中，我们提取了单一药物转换或方案改变的原因，以及社会人口统计学和临床数据。我们拟合了 Cox 回归模型，以确定与 ART 转换（ART 组合中的一种或多种药物变化）相关的因素以及发生的速度。
在 2601 名青少年中，605 名（24.9%）青少年在 5090.5 人年的风险暴露期间（PYAR）转换了 ART，转换率为 11.9/100PYAR。中位随访时间为 4.4（±3.2）年。在多变量分析中，年龄较大的组是 ART 转换风险的保护因素：调整后的危险比[aHR]0.78，95%CI0.62-0.98，转出状态[aHR]1.42[1.11-1.82]。在开始接受 ART 时，HIV 疾病的严重程度越高，即随着世界卫生组织（WHO）临床分期的增加或基线时 CD4 计数的减少，ART 转换的风险就越高。ART 转换的主要原因是副作用（20.0%）、病毒学失败（17.9%）和剂型转换（27.8%）。其他原因包括怀孕、乙型肝炎、结核病和精神病。
ART 转换很频繁，从开始到 7.5 年内以一致的速度发生。ART 转换的主要原因是病毒学失败和药物副作用。
