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 the...
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| Veröffentlicht in: | Tropical medicine & international health 2016-05, Vol.21 (5), p.662-674 |
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| creator | Jiamsakul, Awachana Kerr, Stephen J. Ng, Oon Tek Lee, Man Po Chaiwarith, Romanee Yunihastuti, Evy Van Nguyen, Kinh Pham, Thuy Thanh Kiertiburanakul, Sasisopin Ditangco, Rossana Saphonn, Vonthanak Sim, Benedict L. H. Merati, Tuti Parwati Wong, Wingwai Kantipong, Pacharee Zhang, Fujie Choi, Jun Yong Pujari, Sanjay Kamarulzaman, Adeeba Oka, Shinichi Mustafa, Mahiran Ratanasuwan, Winai Petersen, Boondarika Law, Matthew Kumarasamy, Nagalingeswaran Mean, CV Khol, V Zhao, HX Han, N Li, PCK Lam, W Chan, YT Saghayam, S Ezhilarasi, C Joshi, K Gaikwad, S Chitalikar, A Wirawan, DN Yuliana, F Imran, D Widhani, A Tanuma, J Nishijima, T Na, S Kim, JM Gani, YM David, R Omar, SF Syed Ponnampalavanar, S Azwa, I Nordin, N Uy, E Bantique, R Ku, WW Wu, PC Lim, PL Lee, LS Ohnmar, PS Ruxrungtham, K Avihingsanon, A Chusut, P Sungkanuparph, S Chumla, L Sanmeema, N Sirisanthana, T Kotarathititum, W Praparattanapan, J Kambua, P Sriondee, R Bui, VH Nguyen, THD Cuong, DD Ha, HL Sohn, AH Durier, N Petersen, B Jiamsakul, A Boettiger, DC |
| description | 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 |
| doi_str_mv | 10.1111/tmi.12690 |
| format | Article |
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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'aide de la régression de Cox, sans inclure les périodes sans traitement. Les covariables avec p <0,10 dans les analyses univariées ont été inclus dans les analyses multivariées où p <0,05 a été considéré comme statistiquement significative.
Résultats
Sur 4549 patients de 13 pays d'Asie, 3176 (69,8%) étaient de sexe masculin et l’âge médian était de 34 ans. Au total 111 (2,4%) avaient eu des IT en raison d’EI et 135 (3,0%) avaient eu des IT pour d'autres raisons. Les durées médianes d'interruption étaient de 22 jours pour l’EI et 148 jours pour les IT non liés aux EI. Dans les analyses multivariées, les interruptions > 30 jours ont été associées à l’échec (31‐180 jours, HR = 2,66; IC95%:1,70 à 4,16; 181‐365 jours, HR = 6,22; IC95%: 3,26 à 11,86 et > 365 jours, HR = 9,10; IC95%: 4,27 à 19,38; p <0,001, comparativement à 0‐14 jours). Les raisons pour des IT précédentes n’étaient pas statistiquement significatives (p = 0,158).
Conclusions
Les durées d'interruption de plus de 30 jours étaient le facteur clé associé à une forte augmentation du risque ultérieur de l’échec du traitement. Si l’IT est inévitable, sa durée doit être réduite au minimum afin de réduire le risque d’échec après la reprise du traitement.
Objetivos
Se conoce que las interrupciones del tratamiento (IT) de la terapia antirretroviral combinada (TARc) conllevan a resultados no favorables del tratamiento, pero aún se dan en lugares con recursos limitados. Hemos investigado los efectos del IT asociados con eventos adversos (EAs) y con razones no relacionadas con EA, incluyendo la duración, sobre los fallos en el tratamiento después del reinicio del TARc, en individuos infectados con VIH en Asia.
Métodos
Se incluyeron pacientes iniciando TARc entre 2006‐2013. Se definió IT como para TARc durante >1 día. El fallo en el tratamiento se definió como un fallo virológico, inmunológico o clínico confirmado. El tiempo hasta el fallo en el tratamiento durante TARc se analizó mediante regresión de Cox, sin incluir periodos sin tratamiento. Se incluyeron covariables con p<0.10 en análisis univariables dentro de análisis multivariables, donde p<0.05 era considerado estadísticamente significativo.
Resultados
De 4549 pacientes provenientes de 13 países en Asia, 3176 (69.8%) eran hombres y su edad media era de 34 años. Un total de 111 (2.4%) tenían ITs debido a EAs y 135 (3.0%) tenían ITs por otras razones. El tiempo medio de interrupción era de 22 días para EA y de 148 días para IT no‐EA. En análisis multivariados, las interrupciones >30 días estaban asociadas con fallo (31‐180 días HR=2.66, IC 95% (1.70‐4.16); 181‐365 días HR=6.22, IC 95% (3.26‐11.86); y >365 días HR=9.10, IC 95% (4.27‐19.38), todos p<0.001, comparado con 0‐14 días). Las razones para un IT previo no eran estadísticamente significativas (p=0.158).
Conclusiones
La duración de interrupciones de más de 30 días era un factor clave asociado con grandes incrementos en el subsecuente riesgo de fallo en el tratamiento. Si la IT es inevitable, su duración debería minimizarse para reducir el riesgo de fallo después de retomar el tratamiento.]]></description><identifier>ISSN: 1360-2276</identifier><identifier>EISSN: 1365-3156</identifier><identifier>DOI: 10.1111/tmi.12690</identifier><identifier>PMID: 26950901</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; adverse events ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - adverse effects ; Anti-HIV Agents - therapeutic use ; antiretroviral ; Antiretroviral drugs ; antirretroviral ; antirétroviral ; Asia ; Asie ; CD4 Lymphocyte Count ; Clinical outcomes ; Disease Progression ; Drug Administration Schedule ; Drug Therapy, Combination ; effets indésirables ; eventos adversos ; Female ; HIV ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; interrupción del tratamiento ; interruptions de traitement ; Male ; Medical treatment ; Medication Adherence - psychology ; Medication Adherence - statistics & numerical data ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Time Factors ; Treatment Failure ; treatment interruptions ; Treatment Outcome ; VIH ; Viral Load</subject><ispartof>Tropical medicine & international health, 2016-05, Vol.21 (5), p.662-674</ispartof><rights>2016 John Wiley & Sons Ltd</rights><rights>2016 John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4760-f479f0662c51111cbfbd7e7e8f575b12a5c0014cfae31842cbf738ac90d1d7af3</citedby><cites>FETCH-LOGICAL-c4760-f479f0662c51111cbfbd7e7e8f575b12a5c0014cfae31842cbf738ac90d1d7af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftmi.12690$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftmi.12690$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26950901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jiamsakul, Awachana</creatorcontrib><creatorcontrib>Kerr, Stephen J.</creatorcontrib><creatorcontrib>Ng, Oon Tek</creatorcontrib><creatorcontrib>Lee, Man Po</creatorcontrib><creatorcontrib>Chaiwarith, Romanee</creatorcontrib><creatorcontrib>Yunihastuti, Evy</creatorcontrib><creatorcontrib>Van Nguyen, Kinh</creatorcontrib><creatorcontrib>Pham, Thuy Thanh</creatorcontrib><creatorcontrib>Kiertiburanakul, Sasisopin</creatorcontrib><creatorcontrib>Ditangco, Rossana</creatorcontrib><creatorcontrib>Saphonn, Vonthanak</creatorcontrib><creatorcontrib>Sim, Benedict L. H.</creatorcontrib><creatorcontrib>Merati, Tuti Parwati</creatorcontrib><creatorcontrib>Wong, Wingwai</creatorcontrib><creatorcontrib>Kantipong, Pacharee</creatorcontrib><creatorcontrib>Zhang, Fujie</creatorcontrib><creatorcontrib>Choi, Jun Yong</creatorcontrib><creatorcontrib>Pujari, Sanjay</creatorcontrib><creatorcontrib>Kamarulzaman, Adeeba</creatorcontrib><creatorcontrib>Oka, Shinichi</creatorcontrib><creatorcontrib>Mustafa, Mahiran</creatorcontrib><creatorcontrib>Ratanasuwan, Winai</creatorcontrib><creatorcontrib>Petersen, Boondarika</creatorcontrib><creatorcontrib>Law, Matthew</creatorcontrib><creatorcontrib>Kumarasamy, Nagalingeswaran</creatorcontrib><creatorcontrib>Mean, CV</creatorcontrib><creatorcontrib>Khol, V</creatorcontrib><creatorcontrib>Zhao, HX</creatorcontrib><creatorcontrib>Han, N</creatorcontrib><creatorcontrib>Li, PCK</creatorcontrib><creatorcontrib>Lam, W</creatorcontrib><creatorcontrib>Chan, YT</creatorcontrib><creatorcontrib>Saghayam, S</creatorcontrib><creatorcontrib>Ezhilarasi, C</creatorcontrib><creatorcontrib>Joshi, K</creatorcontrib><creatorcontrib>Gaikwad, S</creatorcontrib><creatorcontrib>Chitalikar, A</creatorcontrib><creatorcontrib>Wirawan, DN</creatorcontrib><creatorcontrib>Yuliana, F</creatorcontrib><creatorcontrib>Imran, D</creatorcontrib><creatorcontrib>Widhani, A</creatorcontrib><creatorcontrib>Tanuma, J</creatorcontrib><creatorcontrib>Nishijima, T</creatorcontrib><creatorcontrib>Na, S</creatorcontrib><creatorcontrib>Kim, JM</creatorcontrib><creatorcontrib>Gani, YM</creatorcontrib><creatorcontrib>David, R</creatorcontrib><creatorcontrib>Omar, SF Syed</creatorcontrib><creatorcontrib>Ponnampalavanar, S</creatorcontrib><creatorcontrib>Azwa, I</creatorcontrib><creatorcontrib>Nordin, N</creatorcontrib><creatorcontrib>Uy, E</creatorcontrib><creatorcontrib>Bantique, R</creatorcontrib><creatorcontrib>Ku, WW</creatorcontrib><creatorcontrib>Wu, PC</creatorcontrib><creatorcontrib>Lim, PL</creatorcontrib><creatorcontrib>Lee, LS</creatorcontrib><creatorcontrib>Ohnmar, PS</creatorcontrib><creatorcontrib>Ruxrungtham, K</creatorcontrib><creatorcontrib>Avihingsanon, A</creatorcontrib><creatorcontrib>Chusut, P</creatorcontrib><creatorcontrib>Sungkanuparph, S</creatorcontrib><creatorcontrib>Chumla, L</creatorcontrib><creatorcontrib>Sanmeema, N</creatorcontrib><creatorcontrib>Sirisanthana, T</creatorcontrib><creatorcontrib>Kotarathititum, W</creatorcontrib><creatorcontrib>Praparattanapan, J</creatorcontrib><creatorcontrib>Kambua, P</creatorcontrib><creatorcontrib>Sriondee, R</creatorcontrib><creatorcontrib>Bui, VH</creatorcontrib><creatorcontrib>Nguyen, THD</creatorcontrib><creatorcontrib>Cuong, DD</creatorcontrib><creatorcontrib>Ha, HL</creatorcontrib><creatorcontrib>Sohn, AH</creatorcontrib><creatorcontrib>Durier, N</creatorcontrib><creatorcontrib>Petersen, B</creatorcontrib><creatorcontrib>Jiamsakul, A</creatorcontrib><creatorcontrib>Boettiger, DC</creatorcontrib><creatorcontrib>TREAT Asia HIV Observational Database (TAHOD)</creatorcontrib><creatorcontrib>the TREAT Asia HIV Observational Database (TAHOD)</creatorcontrib><title>Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD</title><title>Tropical medicine & international health</title><addtitle>Trop Med Int Health</addtitle><description><![CDATA[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'aide de la régression de Cox, sans inclure les périodes sans traitement. Les covariables avec p <0,10 dans les analyses univariées ont été inclus dans les analyses multivariées où p <0,05 a été considéré comme statistiquement significative.
Résultats
Sur 4549 patients de 13 pays d'Asie, 3176 (69,8%) étaient de sexe masculin et l’âge médian était de 34 ans. Au total 111 (2,4%) avaient eu des IT en raison d’EI et 135 (3,0%) avaient eu des IT pour d'autres raisons. Les durées médianes d'interruption étaient de 22 jours pour l’EI et 148 jours pour les IT non liés aux EI. Dans les analyses multivariées, les interruptions > 30 jours ont été associées à l’échec (31‐180 jours, HR = 2,66; IC95%:1,70 à 4,16; 181‐365 jours, HR = 6,22; IC95%: 3,26 à 11,86 et > 365 jours, HR = 9,10; IC95%: 4,27 à 19,38; p <0,001, comparativement à 0‐14 jours). Les raisons pour des IT précédentes n’étaient pas statistiquement significatives (p = 0,158).
Conclusions
Les durées d'interruption de plus de 30 jours étaient le facteur clé associé à une forte augmentation du risque ultérieur de l’échec du traitement. Si l’IT est inévitable, sa durée doit être réduite au minimum afin de réduire le risque d’échec après la reprise du traitement.
Objetivos
Se conoce que las interrupciones del tratamiento (IT) de la terapia antirretroviral combinada (TARc) conllevan a resultados no favorables del tratamiento, pero aún se dan en lugares con recursos limitados. Hemos investigado los efectos del IT asociados con eventos adversos (EAs) y con razones no relacionadas con EA, incluyendo la duración, sobre los fallos en el tratamiento después del reinicio del TARc, en individuos infectados con VIH en Asia.
Métodos
Se incluyeron pacientes iniciando TARc entre 2006‐2013. Se definió IT como para TARc durante >1 día. El fallo en el tratamiento se definió como un fallo virológico, inmunológico o clínico confirmado. El tiempo hasta el fallo en el tratamiento durante TARc se analizó mediante regresión de Cox, sin incluir periodos sin tratamiento. Se incluyeron covariables con p<0.10 en análisis univariables dentro de análisis multivariables, donde p<0.05 era considerado estadísticamente significativo.
Resultados
De 4549 pacientes provenientes de 13 países en Asia, 3176 (69.8%) eran hombres y su edad media era de 34 años. Un total de 111 (2.4%) tenían ITs debido a EAs y 135 (3.0%) tenían ITs por otras razones. El tiempo medio de interrupción era de 22 días para EA y de 148 días para IT no‐EA. En análisis multivariados, las interrupciones >30 días estaban asociadas con fallo (31‐180 días HR=2.66, IC 95% (1.70‐4.16); 181‐365 días HR=6.22, IC 95% (3.26‐11.86); y >365 días HR=9.10, IC 95% (4.27‐19.38), todos p<0.001, comparado con 0‐14 días). Las razones para un IT previo no eran estadísticamente significativas (p=0.158).
Conclusiones
La duración de interrupciones de más de 30 días era un factor clave asociado con grandes incrementos en el subsecuente riesgo de fallo en el tratamiento. Si la IT es inevitable, su duración debería minimizarse para reducir el riesgo de fallo después de retomar el tratamiento.]]></description><subject>Adult</subject><subject>adverse events</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - adverse effects</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>antiretroviral</subject><subject>Antiretroviral drugs</subject><subject>antirretroviral</subject><subject>antirétroviral</subject><subject>Asia</subject><subject>Asie</subject><subject>CD4 Lymphocyte Count</subject><subject>Clinical outcomes</subject><subject>Disease Progression</subject><subject>Drug Administration Schedule</subject><subject>Drug Therapy, Combination</subject><subject>effets indésirables</subject><subject>eventos adversos</subject><subject>Female</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>interrupción del tratamiento</subject><subject>interruptions de traitement</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Medication Adherence - psychology</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>treatment interruptions</subject><subject>Treatment Outcome</subject><subject>VIH</subject><subject>Viral Load</subject><issn>1360-2276</issn><issn>1365-3156</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0U1LHDEYB_BQLNVue-gXKANe9LCazORlchHEt11QvGx7KoRs5olGZpI1mVG8-R36Df0kZnetaKHQXBLIjz_PC0LfCN4j-ez3ndsjJZf4A9oiFWfjijC-sXrjcVkKvok-p3SDMaaU8U9oM1uGJSZb6NeJtWD6VARbDH7Rau-hKfoIuu_A94XzPcQ4LHoXfEa-mEx_vvm22rVDhOLp8XcRIQ1tTrIxdMXscHJ5_AV9tLpN8PXlHqEfpyezo8n4_PJsenR4PjZU5AotFdJizkvDlu2YuZ03AgTUlgk2J6VmBmNCjdVQkZqWGYiq1kbihjRC22qEDta5i2HeQWNyZVG3ahFdp-ODCtqp9z_eXaurcKeoZLKmIgfsvATEcDtA6lXnkoE2jwPCkBQRtZCSlpz-D60qSuqKZ7r9F70JQ_R5EktVYlFLyrLaXSsTQ0oR7GvdBKvlPFRer1qtN9vvbxt9lX_2mcH-Gty7Fh7-naRmF9N15DOa6LB2</recordid><startdate>201605</startdate><enddate>201605</enddate><creator>Jiamsakul, Awachana</creator><creator>Kerr, Stephen J.</creator><creator>Ng, Oon Tek</creator><creator>Lee, Man Po</creator><creator>Chaiwarith, Romanee</creator><creator>Yunihastuti, Evy</creator><creator>Van Nguyen, Kinh</creator><creator>Pham, Thuy Thanh</creator><creator>Kiertiburanakul, Sasisopin</creator><creator>Ditangco, Rossana</creator><creator>Saphonn, Vonthanak</creator><creator>Sim, Benedict L. H.</creator><creator>Merati, Tuti Parwati</creator><creator>Wong, Wingwai</creator><creator>Kantipong, Pacharee</creator><creator>Zhang, Fujie</creator><creator>Choi, Jun Yong</creator><creator>Pujari, Sanjay</creator><creator>Kamarulzaman, Adeeba</creator><creator>Oka, Shinichi</creator><creator>Mustafa, Mahiran</creator><creator>Ratanasuwan, Winai</creator><creator>Petersen, Boondarika</creator><creator>Law, Matthew</creator><creator>Kumarasamy, Nagalingeswaran</creator><creator>Mean, CV</creator><creator>Khol, V</creator><creator>Zhao, HX</creator><creator>Han, N</creator><creator>Li, PCK</creator><creator>Lam, W</creator><creator>Chan, YT</creator><creator>Saghayam, S</creator><creator>Ezhilarasi, C</creator><creator>Joshi, K</creator><creator>Gaikwad, S</creator><creator>Chitalikar, A</creator><creator>Wirawan, DN</creator><creator>Yuliana, F</creator><creator>Imran, D</creator><creator>Widhani, A</creator><creator>Tanuma, J</creator><creator>Nishijima, T</creator><creator>Na, S</creator><creator>Kim, JM</creator><creator>Gani, YM</creator><creator>David, R</creator><creator>Omar, SF Syed</creator><creator>Ponnampalavanar, S</creator><creator>Azwa, I</creator><creator>Nordin, N</creator><creator>Uy, E</creator><creator>Bantique, R</creator><creator>Ku, WW</creator><creator>Wu, PC</creator><creator>Lim, PL</creator><creator>Lee, LS</creator><creator>Ohnmar, PS</creator><creator>Ruxrungtham, K</creator><creator>Avihingsanon, A</creator><creator>Chusut, P</creator><creator>Sungkanuparph, S</creator><creator>Chumla, L</creator><creator>Sanmeema, N</creator><creator>Sirisanthana, T</creator><creator>Kotarathititum, W</creator><creator>Praparattanapan, J</creator><creator>Kambua, P</creator><creator>Sriondee, R</creator><creator>Bui, VH</creator><creator>Nguyen, THD</creator><creator>Cuong, DD</creator><creator>Ha, HL</creator><creator>Sohn, AH</creator><creator>Durier, N</creator><creator>Petersen, B</creator><creator>Jiamsakul, A</creator><creator>Boettiger, DC</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>201605</creationdate><title>Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD</title><author>Jiamsakul, Awachana ; Kerr, Stephen J. ; Ng, Oon Tek ; Lee, Man Po ; Chaiwarith, Romanee ; Yunihastuti, Evy ; Van Nguyen, Kinh ; Pham, Thuy Thanh ; Kiertiburanakul, Sasisopin ; Ditangco, Rossana ; Saphonn, Vonthanak ; Sim, Benedict L. H. ; Merati, Tuti Parwati ; Wong, Wingwai ; Kantipong, Pacharee ; Zhang, Fujie ; Choi, Jun Yong ; Pujari, Sanjay ; Kamarulzaman, Adeeba ; Oka, Shinichi ; Mustafa, Mahiran ; Ratanasuwan, Winai ; Petersen, Boondarika ; Law, Matthew ; Kumarasamy, Nagalingeswaran ; Mean, CV ; Khol, V ; Zhao, HX ; Han, N ; Li, PCK ; Lam, W ; Chan, YT ; Saghayam, S ; Ezhilarasi, C ; Joshi, K ; Gaikwad, S ; Chitalikar, A ; Wirawan, DN ; Yuliana, F ; Imran, D ; Widhani, A ; Tanuma, J ; Nishijima, T ; Na, S ; Kim, JM ; Gani, YM ; David, R ; Omar, SF Syed ; Ponnampalavanar, S ; Azwa, I ; Nordin, N ; Uy, E ; Bantique, R ; Ku, WW ; Wu, PC ; Lim, PL ; Lee, LS ; Ohnmar, PS ; Ruxrungtham, K ; Avihingsanon, A ; Chusut, P ; Sungkanuparph, S ; Chumla, L ; Sanmeema, N ; Sirisanthana, T ; Kotarathititum, W ; Praparattanapan, J ; Kambua, P ; Sriondee, R ; Bui, VH ; Nguyen, THD ; Cuong, DD ; Ha, HL ; Sohn, AH ; Durier, N ; Petersen, B ; Jiamsakul, A ; Boettiger, DC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4760-f479f0662c51111cbfbd7e7e8f575b12a5c0014cfae31842cbf738ac90d1d7af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>adverse events</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - adverse effects</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>antiretroviral</topic><topic>Antiretroviral drugs</topic><topic>antirretroviral</topic><topic>antirétroviral</topic><topic>Asia</topic><topic>Asie</topic><topic>CD4 Lymphocyte Count</topic><topic>Clinical outcomes</topic><topic>Disease Progression</topic><topic>Drug Administration Schedule</topic><topic>Drug Therapy, Combination</topic><topic>effets indésirables</topic><topic>eventos adversos</topic><topic>Female</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>interrupción del tratamiento</topic><topic>interruptions de traitement</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Medication Adherence - psychology</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>treatment interruptions</topic><topic>Treatment Outcome</topic><topic>VIH</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jiamsakul, Awachana</creatorcontrib><creatorcontrib>Kerr, Stephen J.</creatorcontrib><creatorcontrib>Ng, Oon Tek</creatorcontrib><creatorcontrib>Lee, Man Po</creatorcontrib><creatorcontrib>Chaiwarith, Romanee</creatorcontrib><creatorcontrib>Yunihastuti, Evy</creatorcontrib><creatorcontrib>Van Nguyen, Kinh</creatorcontrib><creatorcontrib>Pham, Thuy Thanh</creatorcontrib><creatorcontrib>Kiertiburanakul, Sasisopin</creatorcontrib><creatorcontrib>Ditangco, Rossana</creatorcontrib><creatorcontrib>Saphonn, Vonthanak</creatorcontrib><creatorcontrib>Sim, Benedict L. H.</creatorcontrib><creatorcontrib>Merati, Tuti Parwati</creatorcontrib><creatorcontrib>Wong, Wingwai</creatorcontrib><creatorcontrib>Kantipong, Pacharee</creatorcontrib><creatorcontrib>Zhang, Fujie</creatorcontrib><creatorcontrib>Choi, Jun Yong</creatorcontrib><creatorcontrib>Pujari, Sanjay</creatorcontrib><creatorcontrib>Kamarulzaman, Adeeba</creatorcontrib><creatorcontrib>Oka, Shinichi</creatorcontrib><creatorcontrib>Mustafa, Mahiran</creatorcontrib><creatorcontrib>Ratanasuwan, Winai</creatorcontrib><creatorcontrib>Petersen, Boondarika</creatorcontrib><creatorcontrib>Law, Matthew</creatorcontrib><creatorcontrib>Kumarasamy, Nagalingeswaran</creatorcontrib><creatorcontrib>Mean, CV</creatorcontrib><creatorcontrib>Khol, V</creatorcontrib><creatorcontrib>Zhao, HX</creatorcontrib><creatorcontrib>Han, N</creatorcontrib><creatorcontrib>Li, PCK</creatorcontrib><creatorcontrib>Lam, W</creatorcontrib><creatorcontrib>Chan, YT</creatorcontrib><creatorcontrib>Saghayam, S</creatorcontrib><creatorcontrib>Ezhilarasi, C</creatorcontrib><creatorcontrib>Joshi, K</creatorcontrib><creatorcontrib>Gaikwad, S</creatorcontrib><creatorcontrib>Chitalikar, A</creatorcontrib><creatorcontrib>Wirawan, DN</creatorcontrib><creatorcontrib>Yuliana, F</creatorcontrib><creatorcontrib>Imran, D</creatorcontrib><creatorcontrib>Widhani, A</creatorcontrib><creatorcontrib>Tanuma, J</creatorcontrib><creatorcontrib>Nishijima, T</creatorcontrib><creatorcontrib>Na, S</creatorcontrib><creatorcontrib>Kim, JM</creatorcontrib><creatorcontrib>Gani, YM</creatorcontrib><creatorcontrib>David, R</creatorcontrib><creatorcontrib>Omar, SF Syed</creatorcontrib><creatorcontrib>Ponnampalavanar, S</creatorcontrib><creatorcontrib>Azwa, I</creatorcontrib><creatorcontrib>Nordin, N</creatorcontrib><creatorcontrib>Uy, E</creatorcontrib><creatorcontrib>Bantique, R</creatorcontrib><creatorcontrib>Ku, WW</creatorcontrib><creatorcontrib>Wu, PC</creatorcontrib><creatorcontrib>Lim, PL</creatorcontrib><creatorcontrib>Lee, LS</creatorcontrib><creatorcontrib>Ohnmar, PS</creatorcontrib><creatorcontrib>Ruxrungtham, K</creatorcontrib><creatorcontrib>Avihingsanon, A</creatorcontrib><creatorcontrib>Chusut, P</creatorcontrib><creatorcontrib>Sungkanuparph, S</creatorcontrib><creatorcontrib>Chumla, L</creatorcontrib><creatorcontrib>Sanmeema, N</creatorcontrib><creatorcontrib>Sirisanthana, T</creatorcontrib><creatorcontrib>Kotarathititum, W</creatorcontrib><creatorcontrib>Praparattanapan, J</creatorcontrib><creatorcontrib>Kambua, P</creatorcontrib><creatorcontrib>Sriondee, R</creatorcontrib><creatorcontrib>Bui, VH</creatorcontrib><creatorcontrib>Nguyen, THD</creatorcontrib><creatorcontrib>Cuong, DD</creatorcontrib><creatorcontrib>Ha, HL</creatorcontrib><creatorcontrib>Sohn, AH</creatorcontrib><creatorcontrib>Durier, N</creatorcontrib><creatorcontrib>Petersen, B</creatorcontrib><creatorcontrib>Jiamsakul, A</creatorcontrib><creatorcontrib>Boettiger, DC</creatorcontrib><creatorcontrib>TREAT Asia HIV Observational Database (TAHOD)</creatorcontrib><creatorcontrib>the TREAT Asia HIV Observational Database (TAHOD)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Tropical medicine & international health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jiamsakul, Awachana</au><au>Kerr, Stephen J.</au><au>Ng, Oon Tek</au><au>Lee, Man Po</au><au>Chaiwarith, Romanee</au><au>Yunihastuti, Evy</au><au>Van Nguyen, Kinh</au><au>Pham, Thuy Thanh</au><au>Kiertiburanakul, Sasisopin</au><au>Ditangco, Rossana</au><au>Saphonn, Vonthanak</au><au>Sim, Benedict L. H.</au><au>Merati, Tuti Parwati</au><au>Wong, Wingwai</au><au>Kantipong, Pacharee</au><au>Zhang, Fujie</au><au>Choi, Jun Yong</au><au>Pujari, Sanjay</au><au>Kamarulzaman, Adeeba</au><au>Oka, Shinichi</au><au>Mustafa, Mahiran</au><au>Ratanasuwan, Winai</au><au>Petersen, Boondarika</au><au>Law, Matthew</au><au>Kumarasamy, Nagalingeswaran</au><au>Mean, CV</au><au>Khol, V</au><au>Zhao, HX</au><au>Han, N</au><au>Li, PCK</au><au>Lam, W</au><au>Chan, YT</au><au>Saghayam, S</au><au>Ezhilarasi, C</au><au>Joshi, K</au><au>Gaikwad, S</au><au>Chitalikar, A</au><au>Wirawan, DN</au><au>Yuliana, F</au><au>Imran, D</au><au>Widhani, A</au><au>Tanuma, J</au><au>Nishijima, T</au><au>Na, S</au><au>Kim, JM</au><au>Gani, YM</au><au>David, R</au><au>Omar, SF Syed</au><au>Ponnampalavanar, S</au><au>Azwa, I</au><au>Nordin, N</au><au>Uy, E</au><au>Bantique, R</au><au>Ku, WW</au><au>Wu, PC</au><au>Lim, PL</au><au>Lee, LS</au><au>Ohnmar, PS</au><au>Ruxrungtham, K</au><au>Avihingsanon, A</au><au>Chusut, P</au><au>Sungkanuparph, S</au><au>Chumla, L</au><au>Sanmeema, N</au><au>Sirisanthana, T</au><au>Kotarathititum, W</au><au>Praparattanapan, J</au><au>Kambua, P</au><au>Sriondee, R</au><au>Bui, VH</au><au>Nguyen, THD</au><au>Cuong, DD</au><au>Ha, HL</au><au>Sohn, AH</au><au>Durier, N</au><au>Petersen, B</au><au>Jiamsakul, A</au><au>Boettiger, DC</au><aucorp>TREAT Asia HIV Observational Database (TAHOD)</aucorp><aucorp>the TREAT Asia HIV Observational Database (TAHOD)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD</atitle><jtitle>Tropical medicine & international health</jtitle><addtitle>Trop Med Int Health</addtitle><date>2016-05</date><risdate>2016</risdate><volume>21</volume><issue>5</issue><spage>662</spage><epage>674</epage><pages>662-674</pages><issn>1360-2276</issn><eissn>1365-3156</eissn><abstract><![CDATA[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'aide de la régression de Cox, sans inclure les périodes sans traitement. Les covariables avec p <0,10 dans les analyses univariées ont été inclus dans les analyses multivariées où p <0,05 a été considéré comme statistiquement significative.
Résultats
Sur 4549 patients de 13 pays d'Asie, 3176 (69,8%) étaient de sexe masculin et l’âge médian était de 34 ans. Au total 111 (2,4%) avaient eu des IT en raison d’EI et 135 (3,0%) avaient eu des IT pour d'autres raisons. Les durées médianes d'interruption étaient de 22 jours pour l’EI et 148 jours pour les IT non liés aux EI. Dans les analyses multivariées, les interruptions > 30 jours ont été associées à l’échec (31‐180 jours, HR = 2,66; IC95%:1,70 à 4,16; 181‐365 jours, HR = 6,22; IC95%: 3,26 à 11,86 et > 365 jours, HR = 9,10; IC95%: 4,27 à 19,38; p <0,001, comparativement à 0‐14 jours). Les raisons pour des IT précédentes n’étaient pas statistiquement significatives (p = 0,158).
Conclusions
Les durées d'interruption de plus de 30 jours étaient le facteur clé associé à une forte augmentation du risque ultérieur de l’échec du traitement. Si l’IT est inévitable, sa durée doit être réduite au minimum afin de réduire le risque d’échec après la reprise du traitement.
Objetivos
Se conoce que las interrupciones del tratamiento (IT) de la terapia antirretroviral combinada (TARc) conllevan a resultados no favorables del tratamiento, pero aún se dan en lugares con recursos limitados. Hemos investigado los efectos del IT asociados con eventos adversos (EAs) y con razones no relacionadas con EA, incluyendo la duración, sobre los fallos en el tratamiento después del reinicio del TARc, en individuos infectados con VIH en Asia.
Métodos
Se incluyeron pacientes iniciando TARc entre 2006‐2013. Se definió IT como para TARc durante >1 día. El fallo en el tratamiento se definió como un fallo virológico, inmunológico o clínico confirmado. El tiempo hasta el fallo en el tratamiento durante TARc se analizó mediante regresión de Cox, sin incluir periodos sin tratamiento. Se incluyeron covariables con p<0.10 en análisis univariables dentro de análisis multivariables, donde p<0.05 era considerado estadísticamente significativo.
Resultados
De 4549 pacientes provenientes de 13 países en Asia, 3176 (69.8%) eran hombres y su edad media era de 34 años. Un total de 111 (2.4%) tenían ITs debido a EAs y 135 (3.0%) tenían ITs por otras razones. El tiempo medio de interrupción era de 22 días para EA y de 148 días para IT no‐EA. En análisis multivariados, las interrupciones >30 días estaban asociadas con fallo (31‐180 días HR=2.66, IC 95% (1.70‐4.16); 181‐365 días HR=6.22, IC 95% (3.26‐11.86); y >365 días HR=9.10, IC 95% (4.27‐19.38), todos p<0.001, comparado con 0‐14 días). Las razones para un IT previo no eran estadísticamente significativas (p=0.158).
Conclusiones
La duración de interrupciones de más de 30 días era un factor clave asociado con grandes incrementos en el subsecuente riesgo de fallo en el tratamiento. Si la IT es inevitable, su duración debería minimizarse para reducir el riesgo de fallo después de retomar el tratamiento.]]></abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26950901</pmid><doi>10.1111/tmi.12690</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1360-2276 |
| ispartof | Tropical medicine & international health, 2016-05, Vol.21 (5), p.662-674 |
| issn | 1360-2276 1365-3156 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4959847 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult adverse events Anti-HIV Agents - administration & dosage Anti-HIV Agents - adverse effects Anti-HIV Agents - therapeutic use antiretroviral Antiretroviral drugs antirretroviral antirétroviral Asia Asie CD4 Lymphocyte Count Clinical outcomes Disease Progression Drug Administration Schedule Drug Therapy, Combination effets indésirables eventos adversos Female HIV HIV Infections - drug therapy Human immunodeficiency virus Humans interrupción del tratamiento interruptions de traitement Male Medical treatment Medication Adherence - psychology Medication Adherence - statistics & numerical data Middle Aged Proportional Hazards Models Prospective Studies Risk Factors Time Factors Treatment Failure treatment interruptions Treatment Outcome VIH Viral Load |
| title | Effects of unplanned treatment interruptions on HIV treatment failure – results from TAHOD |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T19%3A42%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20unplanned%20treatment%20interruptions%20on%20HIV%20treatment%20failure%20%E2%80%93%20results%20from%20TAHOD&rft.jtitle=Tropical%20medicine%20&%20international%20health&rft.au=Jiamsakul,%20Awachana&rft.aucorp=TREAT%20Asia%20HIV%20Observational%20Database%20(TAHOD)&rft.date=2016-05&rft.volume=21&rft.issue=5&rft.spage=662&rft.epage=674&rft.pages=662-674&rft.issn=1360-2276&rft.eissn=1365-3156&rft_id=info:doi/10.1111/tmi.12690&rft_dat=%3Cproquest_pubme%3E1783341836%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1782078945&rft_id=info:pmid/26950901&rfr_iscdi=true |