High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.
BACKGROUND
The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC).


METHODS
Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes.


RESULTS
Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART.


CONCLUSIONS
We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing.
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
Nang Thu Thu
http://orcid.org/0000-0002-4849-579X
NT
Kyaw
International Union against Tuberculosis and Lung Disease, Paris, France.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
Anthony D
AD
Harries
International Union against Tuberculosis and Lung Disease, Paris, France.|International Union Against Tuberculosis and Lung disease, The Union South-East Asia Regional Office, New Delhi, India.
Ajay M V
AM
Kumar
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
Myo Minn
MM
Oo
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
Khine Wut Yee
KW
Kyaw
National HIV/AIDS program, Mandalay, Myanmar.
Than
T
Win
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
Thet Ko
TK
Aung
International Union Against Tuberculosis and Lung disease, Mandalay, Myanmar.
Aung Chan
AC
Min
National HIV/AIDS program, Nay Pyi Taw, Myanmar.
Htun Nyunt
HN
Oo
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D002648:Child; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D012189:Retrospective Studies; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
D019380:Anti-HIV Agents