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https://hdl.handle.net/2440/112458
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dc.contributor.author | Wright, S. | - |
dc.contributor.author | Boyd, M. | - |
dc.contributor.author | Yunihastuti, E. | - |
dc.contributor.author | Law, M. | - |
dc.contributor.author | Sirisanthana, T. | - |
dc.contributor.author | Hoy, J. | - |
dc.contributor.author | Pujari, S. | - |
dc.contributor.author | Lee, M. | - |
dc.contributor.author | Petoumenos, K. | - |
dc.contributor.editor | Wainberg, M. | - |
dc.date.issued | 2013 | - |
dc.identifier.citation | PLoS One, 2013; 8(6):e64902-1-e64902-12 | - |
dc.identifier.issn | 1932-6203 | - |
dc.identifier.issn | 1932-6203 | - |
dc.identifier.uri | http://hdl.handle.net/2440/112458 | - |
dc.description.abstract | Background: In the Asia-Pacific region many countries have adopted the WHO's public health approach to HIV care and treatment. We performed exploratory analyses of the factors associated with first major modification to first-line combination antiretroviral therapy (ART) in resource-rich and resource-limited countries in the region. Methods: We selected treatment naive HIV-positive adults from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD). We dichotomised each country's per capita income into high/upper-middle (T-H) and lower-middle/low (T-L). Survival methods stratified by income were used to explore time to first major modification of first-line ART and associated factors. We defined a treatment modification as either initiation of a new class of antiretroviral (ARV) or a substitution of two or more ARV agents from within the same ARV class. Results: A total of 4250 patients had 961 major modifications to first-line ART in the first five years of therapy. The cumulative incidence (95% CI) of treatment modification was 0.48 (0.44-0.52), 0.33 (0.30-0.36) and 0.21 (0.18-0.23) for AHOD, T-H and T-L respectively. We found no strong associations between typical patient characteristic factors and rates of treatment modification. In AHOD, relative to sites that monitor twice-yearly (both CD4 and HIV RNA-VL), quarterly monitoring corresponded with a doubling of the rate of treatment modifications. In T-H, relative to sites that monitor once-yearly (both CD4 and HIV RNA-VL), monitoring twice-yearly corresponded to a 1.8 factor increase in treatment modifications. In T-L, no sites on average monitored both CD4 & HIV RNA-VL concurrently once-yearly. We found no differences in rates of modifications for once- or twice-yearly CD4 count monitoring. Conclusions: Low-income countries tended to have lower rates of major modifications made to first-line ART compared to higher-income countries. In higher-income countries, an increased rate of RNA-VL monitoring was associated with increased modifications to first-line ART. | - |
dc.description.statementofresponsibility | Stephen Wright, Mark A. Boyd, Evy Yunihastuti, Matthew Law, Thira Sirisanthana, Jennifer Hoy, Sanjay Pujari, Man Po Lee, Kathy Petoumenos | - |
dc.language.iso | en | - |
dc.publisher | Public Library of Science | - |
dc.rights | © 2013 Wright et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | - |
dc.source.uri | http://dx.doi.org/10.1371/journal.pone.0064902 | - |
dc.subject | International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific HIV Observational Database (APHOD); antiretroviral therapy | - |
dc.title | Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1371/journal.pone.0064902 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Boyd, M. [0000-0002-6848-3307] | - |
Appears in Collections: | Aurora harvest 3 Medicine publications |
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