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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
Hepatitis-B-Virus
Treatment Response
Cell Count
Infection
Care
Transmission
Metaanalysis
Prevalence
Africa |
| 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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