Adherence, virological outcome, and drug resistance in Chinese HIV patients receiving first-line antiretroviral therapy from 2011 to 2015

Abstract

Stavudine (D4T), zidovudine (AZT), and tenofovir (TDF) along with lamivudine (3TC) are the most widely used HIV treatment regimens in China. China's National Free Antiretroviral Treatment Programme (NFATP) has replaced D4T with AZT or TDF in the standard first-line regimens since 2010. Few studies have evaluated the adherence, virological outcome, and drug resistance in HIV patients receiving first-line antiretroviral therapy (ART) from 2011 to 2015 due to changes in ART regimen.From 2011 to 2015, 2787 HIV patients were examined, with 364, 1453, and 970 patients having initiated D4T-, AZT-, and TDF-based first-line ART regimens, respectively. The Cochran–Armitage test was used to examine the trends in clinical and virological outcomes during 2011 to 2015. Logistic regression was used to examine the effects of different regimens after 9 to 24 months of ART.From 2011 to 2014–2015, adverse drug reactions decreased from 18.9% to 6.7%, missed doses decreased from 9.9% to 4.6%, virological failure decreased from 16.2% to 6.4%, and drug resistance rates also significantly decreased from 5.4% to 1.1%. These successes were strongly associated with the standardized use of TDF- or AZT-based regimens in place of the D4T-based regimen. Poor adherence decreased from 11.3% in patients who initiated D4T-based regimens to 4.9% in those who initiated TDF-based regimens, adverse drug reactions decreased from 32.4% to 6.7%, virological failure reduced from 18.7% to 8.6%, and drug resistance reduced from 5.8% to 2.9%. Compared with patients who initiated AZT-based regimens, patients who initiated TDF-based regiments showed significant reductions in adherence issues, adverse drug reactions, virological outcomes, and drug resistance. Significant differences were also observed between those who initiated D4T- and AZT-based regimens.The good control of HIV replication and drug resistance was attributed to the success of China's NFATP from 2011 to 2015. This study provided real world evidence for further scaling up ART and minimizing the emergence of drug resistance in the “Three 90” era.

Prevalence of acquired drug resistance mutations in antiretroviral- experiencing subjects from 2012 to 2017 in Hunan Province of central South China

“…More than 25,530 HIV/AIDS patients had received free highly active antiretroviral therapy (HAART) and were still in treatment which is supported by the government by the end of 2017. Although stavudine (D4T) and zidovudine (AZT) are not recommended as first-line therapy in the US and Europe, in much of Asia and other resourcelimited settings, the most common first-line regimens for HIV-infected patients still contain either D4T or AZT, which are less costly than tenofovir (TDF) [7][8][9]. The first line regimen of HAART given to patients in Hunan Province China is a triple therapy choosing from d4T, AZT, TDF, 3TC, Efavirenz (EFV) and nevirapine (NVP), all these generic drugs produced in China.…”

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

“…Better adherence to therapy among patients not only leads to virological failure but also reduces HIV resistance to antiretrovirals (ARVs). 19 Although several studies have been conducted in Brazil regarding ART adherence in the northeastern region of this country, more data is still needed, in order to broaden the notions about this issue and, thus, to enable creation of strategies elaborated on the basis of acquired knowledge.…”

“…Additionally, nonadherence to ART is related to virological failure and antiretroviral resistance, with possible dispersion of resistant viruses. Therefore, working to promote adherence is also an important preventive tool within public health 19.…”

HIV drug resistance in patients in China’s national HIV treatment programme who have been on first-line ART for at least 9 months

“…Data collected through the Chinese National HIVDR Surveillance and Monitoring Network since 2003 were analyzed using a retrospective method to assess HIVDR and associated program factors in populations of patients on ART. The database included annual cross-sectional surveys of HIV drug resistance from 2003 to 2015 in China which were described in the previous studies [9,10,14,[16][17][18]. and the methodology was endorsed by WHO for HIVDR Monitoring Survey [6,19].…”

“…Three phases of ART were established according to development stages of NFATP in China: initial and scaleup ART, 2003-2008; standardization and scale-up, 2009-2012; and rapid scale-up, 2013-2015 [13][14][15]. Enormous efforts have been made to develop the capability of treating large numbers of people across wide geographic areas.…”