title: Trends in first-line antiretroviral therapy in Asia: results from the TREAT Asia HIV observational database.
abstract: BACKGROUND
  Antiretroviral therapy (ART) has evolved rapidly since its beginnings. This analysis describes trends in first-line ART use in Asia and their impact on treatment outcomes.
  
  
  METHODS
  Patients in the TREAT Asia HIV Observational Database receiving first-line ART for ≥ 6 months were included. Predictors of treatment failure and treatment modification were assessed.
  
  
  RESULTS
  Data from 4662 eligible patients was analysed. Patients started ART in 2003-2006 (n = 1419), 2007-2010 (n = 2690) and 2011-2013 (n = 553). During the observation period, tenofovir, zidovudine and abacavir use largely replaced stavudine. Stavudine was prescribed to 5.8% of ART starters in 2012/13. Efavirenz use increased at the expense of nevirapine, although both continue to be used extensively (47.5% and 34.5% of patients in 2012/13, respectively). Protease inhibitor use dropped after 2004. The rate of treatment failure or modification declined over time (22.1 [95%CI 20.7-23.5] events per 100 patient/years in 2003-2006, 15.8 [14.9-16.8] in 2007-2010, and 11.6 [9.4-14.2] in 2011-2013). Adjustment for ART regimen had little impact on the temporal decline in treatment failure rates but substantially attenuated the temporal decline in rates of modification due to adverse event. In the final multivariate model, treatment modification due to adverse event was significantly predicted by earlier period of ART initiation (hazard ratio 0.52 [95%CI 0.33-0.81], p = 0.004 for 2011-2013 versus 2003-2006), older age (1.56 [1.19-2.04], p = 0.001 for ≥ 50 years versus <30 years), female sex (1.29 [1.11-1.50], p = 0.001 versus male), positive hepatitis C status (1.33 [1.06-1.66], p = 0.013 versus negative), and ART regimen (11.36 [6.28-20.54], p<0.001 for stavudine-based regimens versus tenofovir-based).
  
  
  CONCLUSIONS
  The observed trends in first-line ART use in Asia reflect changes in drug availability, global treatment recommendations and prescriber preferences over the past decade. These changes have contributed to a declining rate of treatment modification due to adverse event, but not to reductions in treatment failure.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: David Charles
authors.initials: DC
authors.lastname: Boettiger
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kerr
authors.affiliation: Research Institute for Tropical Medicine, Manila, Philippines.
authors.forename: Rossana
authors.initials: R
authors.lastname: Ditangco
authors.affiliation: Udayana University, Sanglah Hospital, Denpesar, Indonesia.
authors.forename: Tuti Parwati
authors.initials: TP
authors.lastname: Merati
authors.affiliation: Bach Mai Hospital, Hanoi, Vietnam.
authors.forename: Thuy Thi Thanh
authors.initials: TT
authors.lastname: Pham
authors.affiliation: Research Institute for Health Sciences, Chiang Mai, Thailand.
authors.forename: Romanee
authors.initials: R
authors.lastname: Chaiwarith
authors.affiliation: Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.affiliation: Queen Elizabeth Hospital, Hong Kong, China SAR.
authors.forename: Chung Ki Patrick
authors.initials: CK
authors.lastname: Li
authors.affiliation: YRG Centre for AIDS Research and Education, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia.
authors.forename: Saphonn
authors.initials: S
authors.lastname: Vonthanak
authors.affiliation: Hospital Sungai Buloh, Sungai Buloh, Malaysia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Kinh
authors.affiliation: Institute of Infectious Diseases, Pune, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pujari
authors.affiliation: Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wing Wai
authors.initials: WW
authors.lastname: Wong
authors.affiliation: University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.affiliation: Beijing Ditan Hospital, Capital Medical University, Beijing, China.
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Evy
authors.initials: E
authors.lastname: Yunihastuti
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.affiliation: National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.affiliation: Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.affiliation: Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand.
authors.forename: Pacharee
authors.initials: P
authors.lastname: Kantipong
authors.affiliation: Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia.
authors.forename: Mahiran
authors.initials: M
authors.lastname: Mustafa
authors.affiliation: Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Winai
authors.initials: W
authors.lastname: Ratanasuwan
authors.affiliation: TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: Annette
authors.initials: A
authors.lastname: Sohn
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D001208:Asia; D015224:Dideoxynucleosides / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000473:pathology*; D005260:Female; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D018119:Stavudine / Q000627:therapeutic use; D000099227:Abacavir
chemical_list: D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D019829:Nevirapine; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine; D000099227:Abacavir