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Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study
OBJECTIVES: China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretr...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475164/ https://www.ncbi.nlm.nih.gov/pubmed/30928945 http://dx.doi.org/10.1136/bmjopen-2018-025666 |
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author | Kang, Ruihua Luo, Liuhong Chen, Huanhuan Zhu, Qiuying Liao, Lingjie Xing, Hui Zhu, Jinhui Shen, Zhiyong Lan, Guanghua Tang, Zhenzhu Shao, Yiming Yang, Wenmin Ruan, Yuhua |
author_facet | Kang, Ruihua Luo, Liuhong Chen, Huanhuan Zhu, Qiuying Liao, Lingjie Xing, Hui Zhu, Jinhui Shen, Zhiyong Lan, Guanghua Tang, Zhenzhu Shao, Yiming Yang, Wenmin Ruan, Yuhua |
author_sort | Kang, Ruihua |
collection | PubMed |
description | OBJECTIVES: China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults. DESIGN: Observational retrospective cohort study. SETTING: Data from 2011 to 2013 in Guangxi, China. PARTICIPANTS: Patients aged ≥18 years (n=25 732) were selected. RESULTS: A total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir–ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based. CONCLUSIONS: Our study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens. |
format | Online Article Text |
id | pubmed-6475164 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-64751642019-05-07 Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study Kang, Ruihua Luo, Liuhong Chen, Huanhuan Zhu, Qiuying Liao, Lingjie Xing, Hui Zhu, Jinhui Shen, Zhiyong Lan, Guanghua Tang, Zhenzhu Shao, Yiming Yang, Wenmin Ruan, Yuhua BMJ Open Infectious Diseases OBJECTIVES: China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults. DESIGN: Observational retrospective cohort study. SETTING: Data from 2011 to 2013 in Guangxi, China. PARTICIPANTS: Patients aged ≥18 years (n=25 732) were selected. RESULTS: A total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir–ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based. CONCLUSIONS: Our study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens. BMJ Publishing Group 2019-03-30 /pmc/articles/PMC6475164/ /pubmed/30928945 http://dx.doi.org/10.1136/bmjopen-2018-025666 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Infectious Diseases Kang, Ruihua Luo, Liuhong Chen, Huanhuan Zhu, Qiuying Liao, Lingjie Xing, Hui Zhu, Jinhui Shen, Zhiyong Lan, Guanghua Tang, Zhenzhu Shao, Yiming Yang, Wenmin Ruan, Yuhua Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title | Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title_full | Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title_fullStr | Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title_full_unstemmed | Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title_short | Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study |
title_sort | treatment outcomes of initial differential antiretroviral regimens among hiv patients in southwest china: comparison from an observational cohort study |
topic | Infectious Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475164/ https://www.ncbi.nlm.nih.gov/pubmed/30928945 http://dx.doi.org/10.1136/bmjopen-2018-025666 |
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