Temporal trends in the discontinuation of first-line antiretroviral therapy.

Abstract

OBJECTIVES:

The aim of this study was to describe the rates and predictors of discontinuing first-line antiretroviral therapy in the different eras of treatment over a nearly 20 year period initiated in British Columbia between 1992 and 2010.

METHODS:

All naive adults who started antiretroviral therapy (first-line antiretroviral therapy) at any hospital or clinic in British Columbia (Canada) in 1992-2010 were included in this population-based retrospective cohort study. We were primarily interested in whether the era of treatment (1992-95, 1996-2000, 2001-05 and 2006-10) was associated with discontinuation (stopping or switching of initial treatment) within 3 years of starting therapy. Weibull survival analysis was used to model the era of treatment and its association with time to discontinuation.

RESULTS:

The study included 7901 patients. Overall, the probability of discontinuing at 12, 24 and 36 months of treatment was 52%, 68% and 76%, respectively. In the adjusted model, variables associated with discontinuing were earlier treatment era, younger age, low adherence and lower baseline CD4 count. Regarding the 2006-10 period, the probability of discontinuing at 12, 24 and 36 months was 36%, 47% and 53%, respectively. In the adjusted model, the variables associated with discontinuation were younger age, female gender, AIDS-defining illnesses at baseline, low adherence and a protease inhibitor (PI)-based regimen.

CONCLUSIONS:

Discontinuation rates of first-line therapy have decreased over time, but are still quite high even for the latest drug combinations. In the most recent era, younger women on a PI regimen and those not achieving optimal adherence had the highest risk of discontinuing first-line antiretroviral therapy.

• Authors: Alejandro Gonzalez-Serna, Keith Chan, Benita Yip, William Chau, Rachel McGovern, Hasina Samji, Viviane Dias Lima, Robert S Hogg, Richard Harrigan
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 69 Issue 8 Pg. 2202-9 (Aug 2014) ISSN: 1460-2091 [Electronic] England
• PMID: 24739147 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-HIV Agents
• Reverse Transcriptase Inhibitors

Topics

• Adult
• Age Factors
• Anti-HIV Agents (administration & dosage, therapeutic use)
• Antiretroviral Therapy, Highly Active
• British Columbia
• CD4 Lymphocyte Count
• Cohort Studies
• Female
• HIV Infections (drug therapy)
• HIV-1 (drug effects)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Reverse Transcriptase Inhibitors (therapeutic use)
• Sex Factors
• Viral Load
• Withholding Treatment (statistics & numerical data)