Virologic Outcome And Their Predictors In HIV Infected Adults Receiving Long Term First-line Antiretroviral Treatment In8Provinces In China

Virologic outcome and their predictors in HIV infected adults receiving long term first-line antiretroviral treatment in8provinces in ChinaBackground With the expansion of the National Free Antiretroviral Treatment Program (NFATP), mortality among patients who have taken antiretroviral treatment (ART) has been decreased greatly. Although an annual free viral load testing was theoretically available to all patients beginning in2007, personnel and laboratory capacity was limited, and subsequently, a large proportion of eligible patients did not benefit from viral load monitoring. Therefore, China lacks a broad virologic outcome assessment for patients who have been on first line ART regimes.Objectives To describe the long term virologic outcome and its trend among HIV infected adults receiving first line ART regime in China. Predicators related to virologic failure were also evaluated.Methods A cross-sectional survey was conducted to assess virologic outcomes among adult patients who have been on first line ART regimes in China. Meanwhile, an observational cohort was established to evaluate virologic outcomes and predictors among patients who have taken first line regimes for longer durations through providing routine lab test and standardized medical records.Results Overall,71.7%of patients sampled demonstrated viral suppression, with lower rates seen among groups with longer treatment durations, which was82%,73%, and67%for treatment duration groups of6-11months,12-23months, and24months and above, respectively. Initial regime, type of care delivery site, and patient adherence significantly affected virologic outcomes among patients sampled. Patients who initially received non-recommended first line regimes instead of recommended regimes experienced a less favorable outcome. Treatment delivered at county hospitals showed better virologic outcomes than that delivered elsewhere, with patients treated at rural village healthcare facilities having the highest rates of virologic failure.Among the1153cases enrolled in the observational cohort,465cases experienced virologic failure events during the4years of follow up and the incidence rate of virologic failure events was11.5/100person-years. The cumulative proportion of virologic failure was increased to44.1%at six years of treatment. Gender, transmission group, initial treatment regime, type of care delivery site, and missed pills were predicators of virologic failure. Some patients in the selected3hospitals did not pick up pills on time and had the risk of stock out.Among the688patients on first line regimes with virologic suppression in2009,29had a viral load greater than1000copies/ml after12months of follow up.22patients were drug resistant to at least one ARVs based on genotypic assay and incidence rate of drug resistance was3.4-4.6/100person-years. Patients who experienced virologic failure have higher risk to occur drug resistance compare those who are success. All22patients were drug resistant to NNRTIs.16patients (72.7%) were drug resistant to both NRTIs and NNRTIs. Mutations that result in drug resistance to antiretrovirals with high frequencies were M184V, K70R, T215Y, D67N, and M41L among NRTIs, and K103N, Y181Cand, and G190A among NNRTIs.Virologic outcomes of patients on first line regimes were related to the immunologic response based on Markov modeling analysis. Patients who experienced virologic failure had a higher probability of immune deterioration and less probability of immune recovery.Conclusions This is the first study in China to evaluate virologic suppression among a national sample of HIV-infected adult patients receiving ART. Virologic outcomes among adult patients receiving first line ART regimes in China is better than other developing countries but still needs to be improved. Treatment regime, care delivery site, and patient adherence predict virologic outcome. Patients are drug resistant to NRTIs and NNRTIs; categories and drugs available should be increased for both first line and second line regimes. The quality of treatment and care in primary health care clinics that provide ART to patients need further improvement with the involvement of community-based organizations. Viral load testing and drug resistance testing is very useful to evaluate the treatment outcomes of populations and individuals.