Predictors of HIV Virologic Failure And Drug Resistance In Chinese Patients After 48 Months Of Antiretroviral Treatment, 2008-2012 Open Access

Kan, Wei (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/wp988k33r?locale=en
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Abstract

Objective: To explore factors associated with HIV virologic failure and drug resistance among HIV-positive Chinese patients four years after initiating first-line 3TC-based antiretroviral treatment (ART) in 2008 at five sentinel sites.

Design: First-line ART initiators who were previously treatment naïve were selected using consecutive ID numbers from the 2008 National Surveillance Database into a prospective cohort study. Questionnaires and Blood samples were collected in 2011 and 2012 to assess the outcomes of interest: virologic failure and HIV drug resistance (HIVDR). Questionnaires and data from National Surveillance Database assessed demographics and drug adherence data.

Results: 536 eligible patients were retained in the study, the 48-month risk for VF was 63(11.8%) and DR was 27(5.0%). 41(7.6%) participants had viral load ≥ 1000 copies/ml in 2011 and 49 (9.1%) participants had viral load ≥ 1000 copies/ml in 2012. 21(3.9%) participants were found to HIVDR 2011, 27 (5.0%) participants were found to have HIVDR in 2012. There were no statistical differences in virological outcomes and drug resistance in 2011 and 2012. Female participants initiated with D4T based regimen were more susceptible to both virological failure (aOR=2.5 95% CI: 1-6.1 P-value=0.04) and HIVDR (aOR=3.6 95% CI: 1-12.6 P-value=0.05), interestingly, male participants showed no such trait (Crude OR=0.6 95% CI: 0.3-1.4 P-value=0.24). 472 (88.1%) participants reported not missing a dose in the past month at the time of survey. Male participants missing doses in past month were more susceptible to both virological failure (aOR=2.8 95% CI: 1.1-7 P-value=0.03) and HIVDR (aOR=9.7 95% CI: 2.1-44.1 P-value<0.01). All 27 participants detected with HIVDR had NNRTI mutations, 21 (77.8%) had NRTI mutations; no protease inhibitor mutations were detected.

Conclusions: Our findings suggested considerably successful treatment outcomes. We found in the study that female participants initiated with D4T based regimens were more vulnerable to virological failure and HIVDR, while male participants had a higher tendency to have challenges with drug adherence.

Table of Contents

Introduction………………………………………………………………………….…3

Ethics Statement ……………………………………………………………………4

Study Design and Data Collection …………………………………………4

Laboratory analysis …………………………………………………....………… 5

Data analysis …………………………………………………………………………6

Results ……………………………………………………………………………......6

Discussion …………………………………………………………………………...9

Conclusions…………………………………………………………………………..13

Acknowledge…………………………………………………………………………13

Transparency Declarations ……………………………………… ………... 14

References……………………………………………………………………………15

Tables/figure…………………………………………………………………………24

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