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Free Content Virologic outcomes of first-line HAART and associated factors among Chinese patients with HIV in three sentinel antiretroviral treatment sites

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Abstract:

Summary Objective  To evaluate HIV drug resistance (HIVDR) among Chinese patients with HIV receiving first-line highly active antiretroviral therapy (HAART). Methods  Based on the WHO HIVDR surveys, a prospective cohort study with 12-month follow-up was conducted to estimate the prevalence of HIV RNA < 1000 copies/ml and HIVDR. Results  A total of 341 study subjects naïve to prior antiretroviral therapy (ART) were followed up for a median of 12.1 months. The overall mortality rate was 9.9 per 100 person-years. The median of CD4 counts increased from 182 cells/mm at baseline to 268 cells/mm at 12 months ( < 0.0001). Of patients with plasma HIV-1 RNA concentrations ≥1000 copies/ml at 12 months, the proportions of resistance to non-nucleoside reverse transcriptase drugs, nucleoside/nucleotide reverse transcriptase inhibitors, and protease inhibitor drugs were 34.2%, 23.7% and 0%, respectively. The overall proportion of HIV RNA < 1000 copies/ml was 85.7% at 12 months. Occupation of farmer (AOR = 0.3, 95% CI: 0.08, 0.94; =0.0393) and HAART counselling and instruction through telephone (AOR = 2.8, 95% CI: 1.4, 5.6; =0.0047) were significantly associated with HIV RNA < 1000 copies/ml. Conclusion  Our study demonstrated that the community-based ART had significant effects on viral suppression and immune recovery. HIVDR should be monitored in the long term to guide informed decisions on preventing HIVDR and choices of first- and second-line regimens.

French
Objectif: 

Evaluer la résistance aux médicaments anti VIH (RHIV) chez les patients VIH chinois recevant le HAART de première ligne. Méthodes: 

Sur base des surveillances OMS de la RVIH, une étude de cohorte prospective comprenant 12 mois de suivi a été menée afin d’évaluer la prévalence de cas avec ARN du VIH <1000 copies/ml et de RVIH. Résultats: 

Un total de 341 sujets naïfs à un traitement antérieur antirétroviral (ART) ont été suivis pendant une période médiane de 12,1 mois. La mortalité globale a été de 9,9 pour 100 personnes-années. La médiane du taux de CD4 a augmenté de 182 cellules/mm3à l’inclusion à 268 cellules/mm3à 12 mois (p <0,0001). Parmi les patients avec des concentrations plasmatiques de l’ARN du VIH 1 ≥ 1000 copies/ml à 12 mois, les proportions de résistance aux médicaments INNTI, INTI et Inhibiteurs de Protéase étaient de 34,2%, 23,7% et 0%, respectivement. La proportion globale des cas avec ARN du VIH <1000 copies/ml était de 85,7%à 12 mois. Le métier d’agriculteur (AOR = 0,3; IC95%: 0,08-0,94, p = 0,0393) et le conseil et instruction sur l’HAART par téléphone (AOR = 2,8; IC95%: 1,4-5,6; p = 0,0047) étaient significativement associés à l’ARN du VIH <1000 copies/ml. Conclusion: 

Notre étude a démontré que l’ART basée sur la communauté avait des effets significatifs sur la suppression virale et la récupération immunitaire. La RVIH devraient être suivie à long terme pour orienter des décisions éclairées sur la prévention de la RVIH et les choix de régimes de 1ère et 2nde ligne.

Keywords: ARN; ARN du VIH; China; Chine; HIV RNA; HIV drug resistance; VIH; antiretroviral therapy; resistencia medicamentos VIH; résistance aux médicaments contre le VIH; terapia antirretroviral; traitement antirétroviral

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2010.02621.x

Affiliations: 1:  State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China 2:  Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China 3:  Anhui Provincial Center for Disease Control and Prevention, Hefei, China 4:  AIDS Research Department, Institute of Microbiology and Epidemiology, Academy of Military Medical Science, Beijing, China 5:  Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Publication date: 2010-11-01

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