Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD

Objectives Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource‐limited settings. We investigated the effects of TI associated with adverse events (AEs) and non‐AE‐related reasons, including their durations, on treatment failure after cART resumption in HIV‐infected individuals in Asia. Methods Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non‐AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31–180 days HR = 2.66, 95%CI (1.70–4.16); 181–365 days HR = 6.22, 95%CI (3.26–11.86); and >365 days HR = 9.10, 95% CI (4.27–19.38), all P < 0.001, compared to 0–14 days). Reasons for previous TI were not statistically significant (P = 0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. Objectifs Les interruptions de traitement (IT) de la thérapie de combinaison d'antirétroviraux (cART) sont connues pour conduire à des résultats de traitement défavorables, mais se produisent encore dans les contextes à ressources limitées. Nous avons étudié les effets des IT associés à des événements indésirables (EI) et à des raisons non liés aux EI, y compris leur durée, l’échec du traitement après la reprise du cART chez les individus infectés par le VIH en Asie. Méthodes Les patients débutant le cART entre 2006‐2013 ont été inclus. L’IT a été définie comme l'arrêt du cART pour > 1 jour. L’échec du traitement a été défini comme confirmé virologiquement, immunologiquement ou l’échec clinique. Le laps de temps jusqu’à l’échec du traitement au cours du cART a été analysé à l'aid