背景:病毒学失败,耐药性,毒性,和其他问题使ART难以保持长期可持续性。这些问题将迫使患者的治疗计划进行修改。这项研究的目的是确定一线抗逆转录病毒治疗是否持久,并确定导致HAART患者改变其首次高效抗逆转录病毒治疗方案的因素。
方法:从10月开始进行回顾性队列研究,2019年3月,2020年在所有区域州,包括亚的斯亚贝巴和迪雷达瓦行政城市。目标人群来自截至2019年10月至少在过去6个月内提供ART服务的所有医疗机构。采用多阶段整群抽样方法选择研究机构和参与者。曾经参加ART治疗服务的患者的简单随机选择的ART医疗记录。我们采用了多状态生存建模(msm)方法,假设每种治疗方案为状态。我们估计患者从一种方案转移到另一种方案的时间到治疗改变/转换的过渡概率。我们估计了过渡概率,预测概率和住院时间以及与患者从一种治疗方案转移到另一种治疗方案相关的因素。
结果:在随访期间,由于各种原因,6种治疗组合中的任何一种(14.4%)至少改变了一次治疗。在患者中,4834(13.26%)只改变了一次治疗,而371(1.1%)不止一次地改变了它。38.6%的时间,由于毒性,进行了治疗改变,另一种感染或合并症,或者另一个因素,其次是新药和其他因素,18.3%的时间,药物供应不足;其中2.6%涉及怀孕;43.1%涉及其他问题。高效抗逆转录病毒疗法(HAART)组合TDF+3TC+NVP,d4T+3TC+NVP,TDF+3TC+EFV对治疗改变的所有原因都很高,29.74%,26.52%,和19.52%的治疗变化,分别。早期治疗修改或方案改变是包括引起主要关注的d4T药物的治疗组合之一。在s=0和30个月过渡开始时停留和移动的可能性增加,但是留下来的可能性下降了。对于此队列数据集,机会性疾病的存在,体重低,基线CD4计数,和基线TB阳性是治疗调整的危险因素.
结论:鉴于当前的研究考虑了国家数据集,为ART药物现状和管理提供了坚实的依据。由于药物毒性,患者在随访期间的某个时间点调整治疗的可能性更高,合并症,药物不可用,和其他因素,根据预测概率再次。基线结核病阳性,低CD4计数,机会性疾病,在该队列数据集中,低体重是治疗调整的危险因素.
BACKGROUND: Virological failure, drug resistance, toxicities, and other issues make it difficult for ART to maintain long-term sustainability. These issues would force a modification in the patient\'s treatment plan. The aim of this research was to determine whether first-line antiretroviral therapy is durable and to identify the factors that lead to patients on HAART changing their first highly active antiretroviral therapy regimen.
METHODS: A retrospective cohort study was conducted from October, 2019-March, 2020 across all regional states including Addis Ababa and Dire Dawa administrative cities. The target population is from all health facilities that have been providing ART service for at least the past 6 months as of October 2019. Multi-stage clustered sampling method was used to select study facilities and participants. Simple random selected ART medical records of patients ever enrolled in ART treatment services. We adopted a multi-state survival modelling (msm) approach assuming each treatment regimen as state. We estimate the transition probability of patients to move from one regimen to another for time to treatment change/switch. We estimated the transition probability, prediction probabilities and length of stay and factor associated with treatment modification of patients to move from one regimen to another.
RESULTS: Any of the six therapy combinations (14.4%) altered their treatment at least once during the follow-up period for a variety of reasons. Of the patients, 4,834 (13.26%) changed their treatments just once, while 371 (1.1%) changed it more than once. For 38.6% of the time, a treatment change was undertaken due to toxicity, another infection or comorbidity, or another factor, followed by New drugs were then made accessible and other factors 18.3% of the time, a drug was out of supply; 2.6% of those instances involved pregnancy; and 43.1% involved something else. Highly active anti-retroviral therapy (HAART) combinations TDF + 3TC + NVP, d4T + 3TC + NVP, and TDF + 3TC + EFV were high to treatment alterations in all reasons of treatment modifications, with 29.74%, 26.52%, and 19.52% treatment changes, respectively. Early treatment modification or regime change is one of the treatment combinations that include the d4T medication that creates major concern. The likelihood of staying and moving at the the start of s = 0 and 30-month transitions increased, but the likelihood of staying were declined. For this cohort dataset, the presence of opportunistic disease, low body weight, baseline CD4 count, and baseline TB positive were risk factors for therapy adjustment.
CONCLUSIONS: Given that the current study took into account a national dataset, it provides a solid basis for ART drug status and management. The patient had a higher likelihood of adjusting their treatment at some point during the follow-up period due to drug toxicity, comorbidity, drug not being available, and other factors, according to the prediction probability once more. Baseline TB positivity, low CD4 count, opportunistic disease, and low body weight were risk factors for therapy adjustment in this cohort dataset.