Trends in first-line antiretroviral therapy in Asia
Patients enrolled in the TREAT Asia HIV Observational Database (TAHOD) and receiving first-line ART were included. Treatment modification was defined as ≥1 drug change and failure was defined according to the WHO 2010 criteria. Logistic regression was used to determine predictors of antiretroviral use. Predictors of modification and failure were analyzed using Cox models.
Data from 7461 eligible patients were analysed. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) have gained popularity over protease inhibitors (PIs) in the past 10 years. The adjusted odds of starting an NNRTI in 2011/12 were 6 times what they were prior to 2002 (p<0.01). Since 2005, lamivudine/emtricitabine has been used by almost 100% of ART initiators whilst tenofovir and zidovudine are replacing the use of stavudine (figure 1). Efavirenz and nevirapine use has changed little over time whilst the waning demand for first-line PIs is now dominated by lopivavir and atazanavir. First-line treatment modification was associated with earlier year of ART start, older age, homosexual and intravenous drug use exposure groups, and prior exposure to mono/dual ART. Treatment failure was associated with earlier year of ART start, low baseline CD4 cell count and previous exposure to mono/dual ART.
The observed trends in first-line ART use in Asia reflect changes in availability and global treatment recommendations. In conjunction with other improvements in HIV care, these changes have resulted in a declining rate of treatment modification and treatment failure over the past decade.
