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J Antimicrob Chemother. 2014 Aug;69(8):2202-9. doi: 10.1093/jac/dku112. Epub 2014 Apr 15.

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

Author information

1
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada aglez-serna@cfenet.ubc.ca.
2
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
3
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada Division of AIDS, Department of Medicine, University of British Columbia, Vancouver V6T1Z4, BC, Canada.
4
BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby V5A1S6 BC, Canada.

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.

KEYWORDS:

ART; HIV-1; risk; treatment

PMID:
24739147
PMCID:
PMC4583232
DOI:
10.1093/jac/dku112
[Indexed for MEDLINE]
Free PMC Article

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