Abstract：
OBJECTIVE: In the context of the advancement of antiretroviral therapy and, as the characteristics of people living with HIV progress toward an aging population, understanding the causes of treatment interruption becomes crucial. The aim of the study was to determine the change in reasons for antiretroviral treatment discontinuation for 12 years. Secondarily, compare annual antiretroviral regimen discontinuation rate and factors associated.
METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term \'interruption\' will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilized Kaplan-Meier methods and Cox proportional models.
RESULTS: We included 789 people living with HIV, predominantly male (81,5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analyzed to the therapeutic optimization (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV ≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes.
CONCLUSIONS: Over the 12 years there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimization being the main reason. Integrase inhibitors-based regimens and singletablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV ≥50 years with comorbidities.
METHODS: We conducted an analysis using data from people living with HIV who were receiving antiretroviral therapy and discontinued it for any reason. The study included people with HIV infection who visited an outpatient hospital pharmacy clinic from January 2010 to December 2021. Two periods were differentiated for the analysis: 2010-2015 and 2016-2021. The reasons for antiretroviral treatment discontinuation followed classification described by Swiss cohort. In the context of this study, it is pertinent to note that the term \'interruption\' will be consistently used in this article to refer to the act of switching or stopping antiretroviral treatment. To examine factors associated with antiretroviral therapy discontinuation, we utilized Kaplan-Meier methods and Cox proportional models.
RESULTS: We included 789 people living with HIV, predominantly male (81,5%). The main reason for discontinuation was clinical decision (50.2%) followed by adverse effects (37.9%). Focusing on clinical decision, we observed a trend change that went from antiretroviral treatment simplification regimen (56.1%) in the first part of the period analyzed to the therapeutic optimization (53.6%) in the second half. Furthermore, factors that were statistically significantly associated with antiretroviral treatment discontinuation were people with HIV ≥50 years (HR 1.60; 95%CI 1.25-2.04), post-discontinuation single-tablet regimen (HR 1.49; 95%CI 1.06-2.11) and antiretroviral drug classes.
CONCLUSIONS: Over the 12 years there has been a change in the main cause of antiretroviral treatment discontinuation, currently therapeutic optimization being the main reason. Integrase inhibitors-based regimens and singletablet regimen strategies were less likely to be discontinued than others antiretroviral drug classes, allowing for better clinical management due to the efficacy profile, especially in people living with HIV ≥50 years with comorbidities.
摘要：
目的：在抗逆转录病毒治疗的进展和，随着艾滋病毒感染者的特点向人口老龄化发展，了解治疗中断的原因变得至关重要。该研究的目的是确定抗逆转录病毒治疗中断12年的原因的变化。其次，比较年度抗逆转录病毒方案停药率和相关因素。
方法：我们使用来自HIV感染者的数据进行了分析，这些人正在接受抗逆转录病毒治疗并因任何原因停止治疗。该研究包括从2010年1月至2021年12月访问门诊医院药房的HIV感染者。分析区分了两个时期：2010-2015年和2016-2021年。停止抗逆转录病毒治疗的原因遵循瑞士队列描述的分类。在这项研究的背景下，值得注意的是，本文中的术语“中断”将始终用于指代转换或停止抗逆转录病毒治疗的行为。为了检查与抗逆转录病毒治疗停止相关的因素，我们使用Kaplan-Meier方法和Cox比例模型。
结果：我们包括789名艾滋病毒感染者，主要是男性（81,5％）。停药的主要原因是临床决定（50.2%），其次是不良反应（37.9%）。专注于临床决策，我们观察到趋势变化,从分析期的前一部分的抗逆转录病毒治疗方案简化(56.1%)到后半部分的治疗优化(53.6%).此外，与停止抗逆转录病毒治疗有统计学意义的因素是HIV患者≥50岁（HR1.60;95CI1.25-2.04），停药后单片治疗方案（HR1.49;95CI1.06-2.11）和抗逆转录病毒药物类别。
结论：在过去的12年中，抗逆转录病毒治疗中断的主要原因发生了变化，目前治疗优化是主要原因。与其他抗逆转录病毒药物类别相比，以整合酶抑制剂为基础的方案和单片方案策略不太可能被停用。由于疗效，允许更好的临床管理，特别是在艾滋病毒感染者≥50岁并有合并症。
方法：我们使用来自HIV感染者的数据进行了分析，这些人正在接受抗逆转录病毒治疗并因任何原因停止治疗。该研究包括从2010年1月至2021年12月访问门诊医院药房的HIV感染者。分析区分了两个时期：2010-2015年和2016-2021年。停止抗逆转录病毒治疗的原因遵循瑞士队列描述的分类。在这项研究的背景下，值得注意的是，本文中的术语“中断”将始终用于指代转换或停止抗逆转录病毒治疗的行为。为了检查与抗逆转录病毒治疗停止相关的因素，我们使用Kaplan-Meier方法和Cox比例模型。
结果：我们包括789名艾滋病毒感染者，主要是男性（81,5％）。停药的主要原因是临床决定（50.2%），其次是不良反应（37.9%）。专注于临床决策，我们观察到趋势变化,从分析期的前一部分的抗逆转录病毒治疗方案简化(56.1%)到后半部分的治疗优化(53.6%).此外，与停止抗逆转录病毒治疗有统计学意义的因素是HIV患者≥50岁（HR1.60;95CI1.25-2.04），停药后单片治疗方案（HR1.49;95CI1.06-2.11）和抗逆转录病毒药物类别。
结论：在过去的12年中，抗逆转录病毒治疗中断的主要原因发生了变化，目前治疗优化是主要原因。与其他抗逆转录病毒药物类别相比，以整合酶抑制剂为基础的方案和单片方案策略不太可能被停用。由于疗效，允许更好的临床管理，特别是在艾滋病毒感染者≥50岁并有合并症。
