title: Factors associated with virological failure in a cohort of combination antiretroviral therapy-treated patients managed at a tertiary referral centre.
abstract: BACKGROUND
  Recent antiretroviral regimens are potent and better tolerated, resulting in a low prevalence of treatment failure. It is important to identify the drivers of virological failure, so that patients at risk can be identified early and prevention strategies implemented.
  
  
  METHODS
  We performed a retrospective case-control study of HIV-positive patients on antiretroviral therapy and managed at The Alfred Hospital during 2010 to evaluate the predictors of virological failure. Controls were matched 3:1 to cases by gender, and by clinical review in the same week as the diagnosis of virological failure in the case. Predictors of virological failure were identified by multivariate conditional logistic regression.
  
  
  RESULTS
  Thirty-nine patients were identified with treatment failure. In the multivariate model, characteristics associated with virological failure were missed clinic appointments in 1 year before virological failure (odds ratio (OR)=13.1, 95% confidence interval (CI): 2.8-61.1), multiple previous combined antiretroviral therapy regimens (OR =4.2, 95% CI:1.2-15.3), current hepatitis C infection (OR=8.6, 95% CI: 1.9-38.7), older age at HIV diagnosis (OR=1.1, 95% CI: 1.0-1.2), younger age at time of virological failure (OR=0.9, 95% CI: 0.8 to 1.0), and CD4 cell count at virological failure (OR=0.7, 95% CI: 0.5 to 0.9).
  
  
  CONCLUSIONS
  Targeted and appropriate adherence support should be provided to treatment-experienced patients, particularly those who have missed clinical appointments and those with hepatitis C coinfection. Further elucidation of the barriers to clinic attendance may optimise linkage and retention in care.
authors.affiliation: Department of Infectious Diseases, The Alfred Hospital, Melbourne, Vic. 3004, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Fong
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Olga
authors.initials: O
authors.lastname: Vujovic
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D006526:Hepatitis C / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D017211:Treatment Failure; D014739:Victoria / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult