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Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy

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ชื่อเรื่อง : Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy
นักวิจัย : Singini I. , Campbell T. , Smeaton L. , Kumarasamy N. , La Rosa A. , Taejareonkul S. , Safren S. , Flanigan T. , Hakim J. , Hughes M.
คำค้น : -
หน่วยงาน : มหาวิทยาลัยเชียงใหม่
ผู้ร่วมงาน : -
ปีพิมพ์ : 2559
อ้างอิง : 15284336 , 2-s2.0-84979993844 , 10.1080/15284336.2016.1201300 , https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84979993844&origin=inward , http://cmuir.cmu.ac.th/jspui/handle/6653943832/41546
ที่มา : -
ความเชี่ยวชาญ : -
ความสัมพันธ์ : -
ขอบเขตของเนื้อหา : -
บทคัดย่อ/คำอธิบาย :

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Background: Practical issues, including cost, hinder implementing virologic monitoring of patients on antiretroviral therapy (ART) in resource-limited settings. We evaluated factors that might guide monitoring frequency and efforts to prevent treatment failure after initial virologic suppression. Methods: Participants were the 911 HIV-infected antiretroviral-naïve adults with CD4 count  < 300 cells/μL who started efavirenz-based ART in the international A5175/PEARLS trial and achieved HIV-1 RNA  < 1000 copies/mL at 24 weeks. Participant report of ART adherence was evaluated using a structured questionnaire in monthly interviews. Adherence and readily available clinical and laboratory measures were evaluated as predictors of late virologic failure (late VF: confirmed HIV-1 RNA ≥1000 copies/mL after 24 weeks). Results: During median follow-up of 3.5 years, 82/911 participants (9%) experienced late VF. Of 516 participants reporting missed doses during the first 24 weeks of ART, 55 (11%) experienced late VF, compared with 27 (7%) of 395 participants reporting no missed doses (hazard ratio: 1.73; 95% CI: 1.08, 2.73). This difference persisted in multivariable analysis, in which lower pre-ART hemoglobin and absence of Grade ≥3 laboratory results prior to week 24 were also associated with higher risk of late VF. Discussion: In this clinical trial, the late VF rate after successful suppression was very low. If achievable in routine clinical practice, virologic monitoring involving infrequent (e.g. annual) measurements might be considered; the implications of this for development of resistance need evaluating. Patients reporting missed doses early after ART initiation, despite achieving initial suppression, might require more frequent measurement and/or strategies for promoting adherence.

บรรณานุกรม :
Singini I. , Campbell T. , Smeaton L. , Kumarasamy N. , La Rosa A. , Taejareonkul S. , Safren S. , Flanigan T. , Hakim J. , Hughes M. . (2559). Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy.
    เชียงใหม่ : มหาวิทยาลัยเชียงใหม่ .
Singini I. , Campbell T. , Smeaton L. , Kumarasamy N. , La Rosa A. , Taejareonkul S. , Safren S. , Flanigan T. , Hakim J. , Hughes M. . 2559. "Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy".
    เชียงใหม่ : มหาวิทยาลัยเชียงใหม่ .
Singini I. , Campbell T. , Smeaton L. , Kumarasamy N. , La Rosa A. , Taejareonkul S. , Safren S. , Flanigan T. , Hakim J. , Hughes M. . "Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy."
    เชียงใหม่ : มหาวิทยาลัยเชียงใหม่ , 2559. Print.
Singini I. , Campbell T. , Smeaton L. , Kumarasamy N. , La Rosa A. , Taejareonkul S. , Safren S. , Flanigan T. , Hakim J. , Hughes M. . Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy. เชียงใหม่ : มหาวิทยาลัยเชียงใหม่ ; 2559.