Journal Article

Predictors of Virologic Failure in HIV-1-Infected Adults Receiving First-Line Antiretroviral Therapy in 8 Provinces in China

Ye Ma, Decai Zhao, Lan Yu, Marc Bulterys, Matthew L. Robinson, Yan Zhao, Zhihui Dou, Philippe Chiliade, Xiaoyu Wei and Fujie Zhang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 2, pages 264-271
Published in print January 2010 | ISSN: 1058-4838
Published online January 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/649215
Predictors of Virologic Failure in HIV-1-Infected Adults Receiving First-Line Antiretroviral Therapy in 8 Provinces in China

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Background

Despite poor primary health care systems, free antiretroviral therapy (ART) has been available in China for >5 years. Virologic outcomes in Chinese patients receiving ART have not been described on a national level.

Methods

A multistage cluster design was used in 8 provinces to randomly select patients who had been receiving first-line ART for at least 6 months, who were stratified into 3 treatment-duration groups. Viral load testing and patient interviews were conducted, and data were linked with national treatment database information. Collected data were analyzed for association with viral suppression by means of multivariate modeling. Adequate viral suppression was defined as a viral load of <400 copies/mL.

Results

Of 5256 patients receiving ART, 3894 met the eligibility criteria, among whom 1153 were analyzed. Overall, 72% demonstrated viral suppression, and 82%, 73%, and 67% of the participants receiving ART for 6–11, 12–23, and ⩾24 months, respectively, experienced viral suppression (P <.001 ). In a multivariate model, treatment given at locations other than county-level hospitals was less likely to achieve viral suppression, with greater odds for inadequate virologic response found at village clinics (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.9–10.1), township health centers (OR, 3.1; 95% CI, 1.7–5.6), and public health clinics (OR, 3.1; 95% CI, 1.7–5.6). Patients receiving didanosine-based regimens were more likely to experience an inadequate virologic response than were those receiving lamivudine-based regimens (OR, 3.9; 95% CI, 2.7–5.7).

Conclusions

China's national ART program is largely successful at suppressing viral load. Care received outside of hospitals and regimens containing didanosine were associated with less favorable virologic outcomes.

Journal Article.  5284 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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