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. 2022 Mar 30;17(3):e0264157.
doi: 10.1371/journal.pone.0264157. eCollection 2022.

Patterns and prognosis of holding regimens for people living with HIV in Asian countries

Jung Ho Kim  1 , Awachana Jiamsakul  2 , Sasisopin Kiertiburanakul  3 , Bui Vu Huy  4 , Suwimon Khusuwan  5 , Nagalingeswaran Kumarasamy  6 , Oon Tek Ng  7 , Penh Sun Ly  8 , Man-Po Lee  9 , Yu-Jiun Chan  10 , Yasmin Mohamed Gani  11 , Iskandar Azwa  12 , Anchalee Avihingsanon  13   14 , Tuti Parwati Merati  15 , Sanjay Pujari  16 , Romanee Chaiwarith  17 , Fujie Zhang  18 , Junko Tanuma  19 , Cuong Duy Do  20 , Rossana Ditangco  21 , Evy Yunihastuti  22 , Jeremy Ross  23 , Jun Yong Choi  1 ; IeDEA Asia-Pacific
Affiliations

Patterns and prognosis of holding regimens for people living with HIV in Asian countries

Jung Ho Kim et al. PLoS One. .

Abstract

The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were considered to be on holding regimen if they had been on combination antiretroviral therapy for at least 6 months, had two confirmed viral loads (VL) ≥1000 copies/mL, and had remained on the same medications for at least 6 months. Survival time was analyzed using Fine and Gray's competing risk regression. Factors associated with CD4 changes and VL <1000 copies/mL were analyzed using linear regression and logistic regression, respectively. A total of 425 PLWH (72.9% male; 45.2% high-income and 54.8% low-to-middle-income country) met criteria for being on a holding regimen. From high-income countries, 63.0% were on protease inhibitors (PIs); from low-to-middle-income countries, 58.4% were on non-nucleoside reverse transcriptase inhibitors (NNRTIs); overall, 4.5% were on integrase inhibitors. The combination of lamivudine, zidovudine, and efavirenz was the most commonly used single regimen (n = 46, 10.8%), followed by lamivudine, zidovudine, and nevirapine (n = 37, 8.7%). Forty-one PLWH (9.7%) died during follow-up (mortality rate 2.0 per 100 person-years). Age >50 years compared to age 31-40 years (sub-hazard ratio [SHR] 3.29, 95% CI 1.45-7.43, p = 0.004), and VL ≥1000 copies/ml compared to VL <1000 copies/mL (SHR, 2.14, 95% CI 1.08-4.25, p = 0.029) were associated with increased mortality, while higher CD4 counts were protective. In our Asia regional cohort, there was a diversity of holding regimens, and the patterns of PI vs. NNRTI use differed by country income levels. Considering the high mortality rate of PLWH with holding regimen, efforts to extend accessibility to additional antiretroviral options are needed in our region.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Schematic representation of definition of holding regimen.
* Regimen A refers to holding regimen.
Fig 2
Fig 2. Changes in the mean CD4 cell counts in patients with holding regimens.
Fig 3
Fig 3. Proportion of undetectable viral load in patient with holding regimens. VL: Viral load.
See this image and copyright information in PMC

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