High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.
<h4>Background</h4>The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the I...
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0171780&type=printable |
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| author | Nang Thu Thu Kyaw Anthony D Harries Ajay M V Kumar Myo Minn Oo Khine Wut Yee Kyaw Than Win Thet Ko Aung Aung Chan Min Htun Nyunt Oo |
| author_facet | Nang Thu Thu Kyaw Anthony D Harries Ajay M V Kumar Myo Minn Oo Khine Wut Yee Kyaw Than Win Thet Ko Aung Aung Chan Min Htun Nyunt Oo |
| author_sort | Nang Thu Thu Kyaw |
| collection | DOAJ |
| description | <h4>Background</h4>The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC).<h4>Methods</h4>Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes.<h4>Results</h4>Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART.<h4>Conclusions</h4>We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing. |
| format | Article |
| id | doaj-art-37a6e86bb4be430c9a78672a6cc6dca6 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-37a6e86bb4be430c9a78672a6cc6dca62025-08-20T03:04:34ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01122e017178010.1371/journal.pone.0171780High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.Nang Thu Thu KyawAnthony D HarriesAjay M V KumarMyo Minn OoKhine Wut Yee KyawThan WinThet Ko AungAung Chan MinHtun Nyunt Oo<h4>Background</h4>The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC).<h4>Methods</h4>Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes.<h4>Results</h4>Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART.<h4>Conclusions</h4>We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0171780&type=printable |
| spellingShingle | Nang Thu Thu Kyaw Anthony D Harries Ajay M V Kumar Myo Minn Oo Khine Wut Yee Kyaw Than Win Thet Ko Aung Aung Chan Min Htun Nyunt Oo High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. PLoS ONE |
| title | High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. |
| title_full | High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. |
| title_fullStr | High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. |
| title_full_unstemmed | High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. |
| title_short | High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. |
| title_sort | high rate of virological failure and low rate of switching to second line treatment among adolescents and adults living with hiv on first line art in myanmar 2005 2015 |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0171780&type=printable |
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