title: Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China.
abstract: 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 > or = 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.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, US Embassy, Beijing, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.forename: Decai
authors.initials: D
authors.lastname: Zhao
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Robinson
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Dou
authors.forename: Philippe
authors.initials: P
authors.lastname: Chiliade
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wei
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002681:China; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents