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Observational Study
. 2016 May;21(5):662-74.
doi: 10.1111/tmi.12690. Epub 2016 Mar 29.

Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD

Awachana Jiamsakul  1 , Stephen J Kerr  1   2   3 , Oon Tek Ng  4 , Man Po Lee  5 , Romanee Chaiwarith  6 , Evy Yunihastuti  7 , Kinh Van Nguyen  8 , Thuy Thanh Pham  9 , Sasisopin Kiertiburanakul  10 , Rossana Ditangco  11 , Vonthanak Saphonn  12 , Benedict L H Sim  13 , Tuti Parwati Merati  14 , Wingwai Wong  15 , Pacharee Kantipong  16 , Fujie Zhang  17 , Jun Yong Choi  18 , Sanjay Pujari  19 , Adeeba Kamarulzaman  20 , Shinichi Oka  21 , Mahiran Mustafa  22 , Winai Ratanasuwan  23 , Boondarika Petersen  24 , Matthew Law  1 , Nagalingeswaran Kumarasamy  25 ; TREAT Asia HIV Observational Database (TAHOD)
Collaborators, Affiliations
Observational Study

Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD

Awachana Jiamsakul et al. Trop Med Int Health. 2016 May.

Abstract

Objectives: Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia.

Methods: Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant.

Results: Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P < 0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (P = 0.158).

Conclusions: Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption.

Keywords: Asia; Asie; HIV; VIH; adverse events; antiretroviral; antirretroviral; antirétroviral; effets indésirables; eventos adversos; interrupción del tratamiento; interruptions de traitement; treatment interruptions.

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Figures

Figure 1
Figure 1. Example of the time-updated reasons for previous treatment interruption variable coding
Abbreviations: TI – treatment interruption, AE – adverse event, cART - combination antiretroviral therapy.
See this image and copyright information in PMC

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