Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE)

Abstract Background: The durability of first line regimen is important to achieve long term treatment success for the management of HIV infection. Our analysis describes the duration of sequential ART regimens and identifies the determinants leading to treatment change in HIV-positive patients initiating in Asia. Methods: All HIV-positive adult patients initiating first-line ART in 2003-2013, from eight clinical sites among seven countries in Asia. Patient follow-up was to May 2014. Kaplan-Meier curves were used to estimate the time to second ART and third ART regimen. Factors associated with treatment durability were assessed using Cox proportional hazards model. Results: A total of 16, 962 patients initiated first-line ART. Of these, 4, 336 patients initiated second-line ART over 38, 798 person-years (pys), a crude rate of 11.2 (95% CI: 10.8-11.5) per 100 pys. The probability of being on first-line ART increased from 83.7% (95% CI: 82.1-85.1%) in 2003-05 to 87.9% (95% CI: 87.1-88.6%) in 2010-13. Third-line ART was initiated by 1, 135 patients over 8, 078 pys, a crude rate of 14.0 (95% CI: 13.3-14.9) per 100 pys. The probability of continuing second-line ART significantly increased from 64.9% (95% CI: 58.5-70.6%) in 2003-05 to 86.2% (95% CI: 84.7-87.6%) in 2010-13. Conclusions: Rates of discontinuation of first and second-line regimens have decreased over the last decade in Asia. Subsequent regimens were of shorter duration compared to the first-line regimen initiated in the same year period. Lower CD4 count and the use of suboptimal regimens were important factors associated with higher risk of treatment switch.