PMID- 29136011
DCOM- 20171226
LR  - 20171226
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 11
DP  - 2017
TI  - Ten year experience with antiretroviral treatment in Cambodia: Trends in patient 
      characteristics and treatment outcomes.
PG  - e0185348
LID - 10.1371/journal.pone.0185348 [doi]
AB  - BACKGROUND: Although HIV disease stage at ART initiation critically determines
      ART outcomes, few reports have longitudinally monitored this within Asia. Using
      prospectively collected data from a large ART program at Sihanouk Hospital Center
      of Hope in Cambodia, we report on the change in patient characteristics and
      outcomes over a ten-year period. METHODS: We conducted a retrospective analysis
      including all adults (>/= 18 years old) starting ART from March 2003-March 2013
      in a non-governmental hospital in Phnom Penh, Cambodia. The cumulative incidence 
      of death, lost to follow-up (LTFU), attrition (death or LTFU) and first line
      treatment failure were calculated using Kaplan-Meier methods. Independent risk
      factors for these outcomes were determined using Cox regression modeling.
      RESULTS: Over the ten-year period, 3581 patients initiated ART with a median
      follow-up time of 4.8 years (IQR 2.8-7.2). The median age was 35 years (IQR
      30-41), 54% were female. The median CD4 count at ART initiation increased from 22
      cells/muL (IQR 4-129) in 2003 to 218 (IQR 57-302) in 2013. Over the 10 year
      period, a total of 282 (7.9%) individuals died and 433 (12.1%) were defined LTFU.
      Program attrition (died or LTFU) was 11.1% (95% CI: 10.1%- 12.4%) at one year,
      16.3% (95% CI: 15.1%-17.6%) at three years, 19.8% (95% CI: 18.5%-21.2%) at five
      years and 23.3% (95% CI: 21.6-25.1) at ten years. Male sex and low baseline body 
      mass index (BMI) were associated with increased attrition. Factors independently 
      associated with mortality included a low baseline CD4 count, older age, male sex,
      low baseline BMI and hepatitis B co-infection. Individuals aged above 40 years
      old had an increased risk of mortality but were less likely to LTFU. There were a
      total of 137 individuals with first line ART failure starting second line
      treatment. The probability of first line failure was estimated at 2.8% (95% CI:
      2.3%-3.4%) at 3 years, 4.6% (95% CI: 3.9%-5.5%) at 5 years and 7.8% (95% CI
      4.8%-12.5%) at ten years of ART. The probability was particularly high in the
      first few program years. A lower risk was observed among individuals starting ART
      during the 2006-2008 period. Factors independently associated with an increased
      risk of treatment failure included ART-experience, NVP-based ART and a baseline
      CD4 count below 200 cells/muL. CONCLUSIONS: Overall program outcomes were fair,
      and generally compare well to other reports from the region. Despite gradually
      earlier initiation of ART over the ten year period, ART is still initiated at too
      low CD4 count levels, warranting increased efforts for early HIV diagnosis and
      enrolment/retention into HIV care. Tailored strategies for poor prognostic groups
      (older age, male, low BMI) should be designed and evaluated.
FAU - Lay, Phirum
AU  - Lay P
AD  - Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
FAU - An, Sokkab
AU  - An S
AD  - Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
FAU - Soeung, Sunpiseth
AU  - Soeung S
AD  - Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
FAU - Srey, Pich Sovannary
AU  - Srey PS
AD  - Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
FAU - Thai, Sopheak
AU  - Thai S
AD  - Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
FAU - Lynen, Lutgarde
AU  - Lynen L
AD  - Institute of Tropical Medicine, Antwerp, Belgium.
FAU - Griensven, Johan van
AU  - Griensven JV
AD  - Institute of Tropical Medicine, Antwerp, Belgium.
LA  - eng
PT  - Journal Article
DEP - 20171114
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antiviral Agents)
SB  - IM
MH  - Adult
MH  - Antiviral Agents/*therapeutic use
MH  - Body Mass Index
MH  - CD4 Lymphocyte Count
MH  - Cambodia
MH  - Female
MH  - HIV Infections/complications/*drug therapy
MH  - Hepatitis B/complications
MH  - Humans
MH  - Male
MH  - Probability
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC5685593
EDAT- 2017/11/15 06:00
MHDA- 2017/12/27 06:00
CRDT- 2017/11/15 06:00
PHST- 2016/11/26 00:00 [received]
PHST- 2017/09/11 00:00 [accepted]
PHST- 2017/11/15 06:00 [entrez]
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2017/12/27 06:00 [medline]
AID - 10.1371/journal.pone.0185348 [doi]
AID - PONE-D-16-44002 [pii]
PST - epublish
SO  - PLoS One. 2017 Nov 14;12(11):e0185348. doi: 10.1371/journal.pone.0185348.
      eCollection 2017.