title: Determinants of virological failure after 1 year's antiretroviral therapy in Vietnamese people with HIV: findings from a retrospective cohort of 13 outpatient clinics in six provinces.
abstract: OBJECTIVE
  This study examines the proportions and causes of virological failure after one year of antiretroviral therapy (ART) among people living with HIV (PLHIV) in Vietnam. It also evaluates the positive predictive value (PPV) of immunological criteria to detect treatment failure.
  
  
  METHODS
  A retrospective cohort of 3449 people with HIV who started ART between 1 January 2005 and 31 December 2009 in 13 outpatient clinics in Vietnam was studied. Multivariate logistic regression modeling was used to calculate crude and adjusted ORs and 95% CIs for associations between patient characteristics and virological failure.
  
  
  RESULTS
  An estimated 6.5% (226/3449) of HIV patients in the participating clinics in Vietnam had confirmed virological failure one year after the start of ART. After adjusting for other factors, patients with a baseline CD4 count of 50-100 cells/mm(3) and 101-200 cells/mm(3) were statistically significantly less likely to have virological failure, compared to those with a baseline CD4 count lower than 50 cells/mm(3) (OR=0.61, 95% CI 0.23-0.89; and OR=0.43, 0.18-0.78, respectively). In contrast, patients with a history of injecting drug use were statistically significantly more likely to have viraemia than otherwise (OR=1.32, 1.16-1.67). The PPV of the WHO immunological criteria was 60.1% (57.1-69.3%).
  
  
  CONCLUSIONS
  Routine viral load tests should be conducted early to detect virological failure and prevent unnecessary changes to second-line treatments. To improve treatment outcomes, timely ART initiation and adherence to treatment among those with history of injecting drug use should be promoted.
authors.affiliation: Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Dam Anh
authors.initials: DA
authors.lastname: Tran
authors.affiliation: Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
authors.affiliation: National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Shakeshaft
authors.affiliation: The University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Anh Duc
authors.initials: AD
authors.lastname: Ngo
authors.affiliation: Hunter Medical Research Centre, The University of Newcastle, Newcastle, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Doran
authors.affiliation: Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019829:Nevirapine / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018119:Stavudine / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; C516355:stavudine, lamivudine, nevirapine drug combination; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine
keywords: ADHERENCE; ANTERETROVIRAL THERAPY; HIV; VIROLOGY HIV