title: Temporal trends in the discontinuation of first-line antiretroviral therapy.
abstract: OBJECTIVE
  The aim of this study was to describe the rates and predictors of discontinuing first-line antiretroviral therapy in the different eras of treatment over a nearly 20 year period initiated in British Columbia between 1992 and 2010.
  
  
  METHODS
  All naive adults who started antiretroviral therapy (first-line antiretroviral therapy) at any hospital or clinic in British Columbia (Canada) in 1992-2010 were included in this population-based retrospective cohort study. We were primarily interested in whether the era of treatment (1992-95, 1996-2000, 2001-05 and 2006-10) was associated with discontinuation (stopping or switching of initial treatment) within 3 years of starting therapy. Weibull survival analysis was used to model the era of treatment and its association with time to discontinuation.
  
  
  RESULTS
  The study included 7901 patients. Overall, the probability of discontinuing at 12, 24 and 36 months of treatment was 52%, 68% and 76%, respectively. In the adjusted model, variables associated with discontinuing were earlier treatment era, younger age, low adherence and lower baseline CD4 count. Regarding the 2006-10 period, the probability of discontinuing at 12, 24 and 36 months was 36%, 47% and 53%, respectively. In the adjusted model, the variables associated with discontinuation were younger age, female gender, AIDS-defining illnesses at baseline, low adherence and a protease inhibitor (PI)-based regimen.
  
  
  CONCLUSIONS
  Discontinuation rates of first-line therapy have decreased over time, but are still quite high even for the latest drug combinations. In the most recent era, younger women on a PI regimen and those not achieving optimal adherence had the highest risk of discontinuing first-line antiretroviral therapy.
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada aglez-serna@cfenet.ubc.ca.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gonzalez-Serna
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
authors.forename: Benita
authors.initials: B
authors.lastname: Yip
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Chau
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: McGovern
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada.
authors.forename: Hasina
authors.initials: H
authors.lastname: Samji
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada Division of AIDS, Department of Medicine, University of British Columbia, Vancouver V6T1Z4, BC, Canada.
authors.forename: Viviane Dias
authors.initials: VD
authors.lastname: Lima
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby V5A1S6 BC, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: BC Centre for Excellence on HIV/AIDS, Vancouver V6Z1Y6, BC, Canada Division of AIDS, Department of Medicine, University of British Columbia, Vancouver V6T1Z4, BC, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Harrigan
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012737:Sex Factors; D019562:Viral Load; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors
keywords: ART; HIV-1; risk; treatment
references.citation: J Antimicrob Chemother. 2007 Oct;60(4):724-32
references.pmid: 17715125
references.citation: HIV Med. 2007 Apr;8(3):186-91
references.pmid: 17461863
references.citation: AIDS. 2002 May 3;16(7):1051-8
references.pmid: 11953472
references.citation: HIV Med. 2010 Feb;11(2):104-13
references.pmid: 19732176
references.citation: Am J Epidemiol. 1993 Dec 1;138(11):923-36
references.pmid: 8256780
references.citation: Prog Lipid Res. 2003 Mar;42(2):81-92
references.pmid: 12547652
references.citation: J Int Assoc Physicians AIDS Care (Chic). 2012 Mar-Apr;11(2):134-41
references.pmid: 22318879
references.citation: AIDS. 2001 Jan 26;15(2):185-94
references.pmid: 11216926
references.citation: JAMA. 2006 Aug 16;296(7):827-43
references.pmid: 16905788
references.citation: J Acquir Immune Defic Syndr. 2003 Dec 1;34(4):407-14
references.pmid: 14615659
references.citation: AIDS Res Hum Retroviruses. 2005 Sep;21(9):743-52
references.pmid: 16218797
references.citation: AIDS. 2000 Mar 31;14(5):499-507
references.pmid: 10780712
references.citation: Curr Opin HIV AIDS. 2011 Dec;6 Suppl 1:S3-11
references.pmid: 22156777
references.citation: Intervirology. 2012;55(2):160-6
references.pmid: 22286887
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1999 Mar 1;20(3):290-4
references.pmid: 10077179
references.citation: Lancet. 2006 Dec 16;368(9553):2125-35
references.pmid: 17174704
references.citation: AIDS Behav. 2013 Jan;17(1):68-73
references.pmid: 22249956
references.citation: AIDS. 2012 Jun 19;26(10):1231-41
references.pmid: 22706009
references.citation: BMC Infect Dis. 2012 Nov 12;12:296
references.pmid: 23145925
references.citation: Curr HIV/AIDS Rep. 2011 Dec;8(4):277-87
references.pmid: 21989672
references.citation: HIV Med. 2006 Apr;7(3):156-62
references.pmid: 16494629
references.citation: AIDS Behav. 2011 Jan;15(1):214-27
references.pmid: 20799061
references.citation: AIDS. 2001 Jan 26;15(2):201-9
references.pmid: 11216928
references.citation: Antivir Ther. 2013;18 Suppl 2:27-34
references.pmid: 23784804
references.citation: AIDS. 1999 Apr 16;13(6):F35-43
references.pmid: 10397555
references.citation: AIDS Patient Care STDS. 2009 Mar;23(3):185-94
references.pmid: 19866536
references.citation: J Infect Dis. 2008 Jun 15;197(12):1685-94
references.pmid: 18513155
references.citation: Lancet Infect Dis. 2012 Feb;12(2):119-27
references.pmid: 21988895
references.citation: Antivir Ther. 2013;18(3):345-354
references.pmid: 23072939
references.citation: Arch Intern Med. 2010 Jan 11;170(1):57-65
references.pmid: 20065200
references.citation: AIDS Res Hum Retroviruses. 2013 Apr;29(4):698-703
references.pmid: 23151191
references.citation: N Engl J Med. 2008 May 15;358(20):2095-106
references.pmid: 18480202
references.citation: J Acquir Immune Defic Syndr. 2005 Jan 1;38(1):96-103
references.pmid: 15608532
references.citation: AIDS. 2010 Oct 23;24(16):2469-79
references.pmid: 20829678