Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

Guy, Rebecca; WandHandan,; McManus, Hamish; VonthanakSaphonn,; Woolley, Ian; HondaMiwako,; ReadTim,; SirisanthanaThira,; ZhouJulian,; Andrew, Treat Asia Hiv Observation Database

doi:10.1089/apc.2012.0439

Cited by 25 publications

(17 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A linkage study of the Australian HIV Observational Database (AHOD), which has an LTFU rate similar to that of TAHOD, revealed that being LTFU was not associated with increased risk of mortality. 30,31 Overall, the effects of other adjusted characteristics in the regression models are consistent with previous findings. 4,12,16,32,33 Age and CD4 count were both significantly associated with the three treatment outcomes.…”

Section: Ten Years Of Cart In Tahod 777supporting

confidence: 89%

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

Jiamsakul¹

2016

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

Asian countries have seen the expansion of combination antiretroviral therapy (cART) over the past decade. The TREAT Asia HIV Observational Database (TAHOD) was established in 2003 comprising 23 urban referral sites in 13 countries across the region. We examined trends in treatment outcomes in patients who initiated cART between 2003 and 2013. Time of cART initiation was grouped into three periods: 2003-2005, 2006-2009, and 2010-2013. We analyzed trends in undetectable viral load (VL; defined as VL <400 copies/ml), CD4 changes from pre-cART levels, and overall survival. Of 6,521 patients included, the overall median CD4 count at cART initiation was 120 cells/ll (interquartile range: 38-218). Despite an increase over time, pre-cART CD4 counts remained <200 cells/ll. Adjusted analyses showed undetectable VL was more likely when starting cART in later years [2006-2009: No differences in CD4 response was observed over time. Age and CD4 levels prior to cART initiation were associated with all three treatment outcomes, with older age and higher CD4 counts being associated with undetectable VL. Survival and VL response on cART have improved over the past decade in TAHOD, although CD4 count at cART initiation remained low. Greater effort should be made to facilitate earlier HIV diagnosis and linkage to care and treatment, to achieve greater improvements in treatment outcomes.

show abstract

Section: Ten Years Of Cart In Tahod 777supporting

confidence: 89%

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

Jiamsakul¹

2016

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

show abstract

“…Patients experiencing AEs are more likely to have treatment modifications, interruptions and/or discontinuations . Although the prevalence of TIs has fallen over recent years, drug toxicities and side effects have remained the most common causes of TI . Unplanned cART interruptions may be unavoidable when there are drug stock‐outs, to manage cART‐related AEs, or when there are adherence challenges.…”

Section: Introductionmentioning

confidence: 99%

Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD

Jiamsakul¹,

Kerr²,

et al. 2016

Tropical Med Int Health

View full text Add to dashboard Cite

Objectives Treatment interruptions (TI) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Methods Patients initiating cART between 2006-2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Co-variables with p<0.10 in univariable analyses were included in multivariable analyses, where p<0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR=2.66, 95%CI (1.70-4.16); 181-365 days HR=6.22, 95%CI (3.26-11.86); and >365 days HR=9.10, 95% CI (4.27-19.38), all p<0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (p=0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption.

show abstract

“…Treatment has become more widely available, but few data have been published on rates of retention and predictors of loss to follow-up (LTFU) among people at highrisk of HIV-infection enrolled on immediate ART. Studies carried out in the general population have shown that LTFU ranged between 14 and 18% for the people living with HIV initiated on ART with some studies indicating that 41% of the LTFU occurred within the first 6 months of ART initiation [16][17][18]. We build on this work with a cohort of HIV positive women who started ART in a "Test and Treat" facility in Kampala, Uganda during the period of August 2014 to March 2018.…”

mentioning

confidence: 99%

Predictors of lost to follow-up in a “test and treat” programme among adult women with high-risk sexual behavior in Kampala, Uganda

et al. 2020

View full text Add to dashboard Cite

Background: Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". Methods: We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women ≥18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for ≥3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. Results: The mean (±SD) age of the 293 study participants was 30.3 (± 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. Conclusion: LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.

show abstract

Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

Cited by 25 publications

References 41 publications

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

A Decade of Combination Antiretroviral Treatment in Asia: The TREAT Asia HIV Observational Database Cohort

Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD

Predictors of lost to follow-up in a “test and treat” programme among adult women with high-risk sexual behavior in Kampala, Uganda

Contact Info

Product

Resources

About