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PLoS One. 2013 Jun 28;8(6):e64902. doi: 10.1371/journal.pone.0064902. Print 2013.

Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region.

Collaborators (181)

Ellis D, Bloch M, Franic T, Agrawal S, McCann L, Cunningham N, Vincent T, Allen D, Little JL, Smith D, Gray C, Baker D, Vale R, Templeton DJ, O'Connor CC, Dijanosic C, Jackson E, McCallum K, Grotowski M, Taylor S, Cooper D, Carr A, Lee F, Hesse K, Sinn K, Norris R, Finlayson R, Prone I, Jackson E, Shakeshaft J, Brown K, McGrath C, McGrath V, Halligan S, Wray L, Read P, Lu H, Couldwell D, Smith D, Furner V, Watson J, Lawrence C, Mulhall B, Law M, Petoumenos K, Wright S, McManus H, Bendall C, Boyd M, Kulatunga A, Knibbs P, Chuah J, Ngieng M, Dickson B, Russell D, Downing S, Sowden D, Broom J, Taing K, Johnston C, McGill K, Orth D, Youds D, Kelly M, Gibson A, Magon H, Donohue W, Moore R, Edwards S, Liddle R, Locke P, Roth NJ, Nicolson J, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Skett J, Robinson J, Mean CV, Saphonn V, Vohith K, Zhang FJ, Zhao HX, Han N, Li PC, Lee MP, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Makane A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Oka S, Tanuma J, Nishijima T, Choi JY, S N, Kim JM, Lee CK, Sim BH, David R, Kamarulzaman A, Kajindran A, Ditangco R, Uy E, Bantique R, Chen YM, Wong WW, Kuo LH, Ng OT, Chua A, Lee LS, Loh A, Phanuphak P, Ruxrungtham K, Avihingsanon A, Khongphattanayothin M, Kiertiburanakul S, Sungkanuparph S, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Kantipong P, Kambua P, Nguyen VK, Bui VH, Cao TT, Pham TT, Cuong DD, Ha HL, Sohn AH, Durier N, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Sowden D, Templeton DJ, Hoy J, Wray L, Chuah J, Morwood K, Read T, Roth N, Woolley I, Kelly M, Broom J, Li PC, Lee MP, Vanar S, Faridah S, Kamarulzaman A, Choi JY, Vannary B, Ditangco R, Tsukada K, Han SH, Pujari S, Makane A, Ng OT, Sasisopin AJ, Drummond F, Boyd M.



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.


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.


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.


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.

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