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    標題: Trends and outcomes of late initiation of combination antiretroviral therapy driven by late presentation among HIV-positive Taiwanese patients in the era of treatment scale-up
    作者: Lin, Kuan-Yin
    Cheng, Chien-Yu
    Li, Chia-Wen
    Yang, Chia-Jui
    Tsai, Mao-Song
    Liu, Chun-Eng
    Lee, Yuan-Ti
    Tang, Hung-Jen
    Wang, Ning-Chi
    Lin, Te-Yu
    Lee, Yi-Chien
    Lin, Shih-Ping
    Huang, Yu-Shan
    Zhang, Jun-Yu
    Ko, Wen-Chien
    Cheng, Shu-Hsing
    Hung, Chien-Ching
    貢獻者: Natl Taiwan Univ Hosp, Dept Med, Jin Shan Branch
    Minist Hlth & Welf,Taoyuan Gen Hosp, Dept Internal Med
    Natl Yang Ming Univ, Sch Publ Hlth
    Natl Cheng Kung Univ Hosp, Dept Internal Med
    Natl Cheng Kung Univ, Dept Med, Med Coll
    Far Eastern Mem Hosp, Dept Internal Med
    Natl Yang Ming Univ, Sch Med
    Changhua Christian Hosp, Dept Internal Med
    Chung Shan Med Univ, Sch Med
    Chung Shan Med Univ Hosp, Dept Internal Med
    Chi Mei Med Ctr, Dept Internal Med
    Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
    Triserv Gen Hosp, Dept Internal Med
    Natl Def Med Ctr
    Ditmanson Med Fdn,Chia Yi Christian Hosp, Dept Internal Med
    Taichung Vet Gen Hosp, Dept Internal Med
    Natl Taiwan Univ Hosp, Dept Internal Med, Hsin Chu Branch
    Natl Taiwan Univ Hosp, Dept Internal Med
    Natl Taiwan Univ, Coll Med
    Natl Taiwan Univ, Coll Med, Dept Parasitol
    China Med Univ Hosp, Dept Med Res
    China Med Univ
    關鍵字: Transmitted Drug-Resistance
    Treatment Response
    Cell Count
    日期: 2017-06-30
    上傳時間: 2018-11-30 15:55:45 (UTC+8)
    出版者: Public Library Science
    摘要: Objectives The international and national HIV treatment guidelines in 2016 have focused on scaling up access to combination antiretroviral therapy (cART). We aimed to assess the trends and treatment outcomes of late cART initiation in Taiwan. Methods Between June 2012 and May 2016, we retrospectively included antiretroviral-naive HIV-positive adults who initiated cART. Late initiation was defined as when cART was initiated in patients with a CD4 count <200 cells/mm(3) or having experienced AIDS-defining illnesses. The treatment outcomes were assessed up to 6 months after starting cART. Results We included 3655 HIV-positive patients, and the majority of the patients were male (95.4%) with a median age of 31 years and initiated non-nucleoside reverse-transcriptase inhibitor-containing regimens (87.0%). The median CD4 count at cART initiation increased from 207 cells/mm 3 in 2012 to 298 cells/mm 3 in 2016, and the overall proportion of late cART initiation decreased from 49.1% in 2012 to 29.0% in 2016 (P for trend <0.001). Late cART initiation mainly resulted from late presentation for HIV care and was associated with older age (per 1-year increase, adjusted odds ratio [AOR], 1.05; 95% CI, 1.04-1.06), HBsAg seropositivity (AOR, 1.31; 95% CI, 1.04-1.64), HIV care in central and southern Taiwan, initiating cART in earlier year, non-intravenous drug users (AOR, 1.96; 95% CI, 1.33-2.86), and negative hepatitis C serostatus (AOR, 1.47; 95% CI, 1.04-2.08). Compared with non-late initiators, late initiators had a higher rate of all-cause mortality (1.7% vs. 0.3%) and regimen modification due to virological failure (7.1% vs. 2.6%). The predicting factors of all-cause mortality were late cART initiation (adjusted hazard ratio [AHR], 5.40; 95% CI, 2.14-13.65) and older age (AHR, 1.06; 95% CI, 1.03-1.10). Conclusions While the proportion of late cART initiation decreased over time in Taiwan, late initiation remained in a substantial proportion of HIV-positive patients. The late initiators had higher risk for poor outcomes. The need for strategies to earlier detection of HIV infection and expediting cART initiation should be highlighted, especially among the older population.
    關聯: Plos One, v.12, n.6, e0179870
    顯示於類別:[保健營養系(所) ] 期刊論文


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