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Risk factors for antiretroviral therapy (ART) discontinuation in a large multinational trial of early ART initiators

Bansi-Matharu, L; Loria, GR; Cole, SR; Mugerwa, H; Vecino, I; Lundgren, J; Pulik, P; ... INSIGHT START Study Group, ; + view all (2019) Risk factors for antiretroviral therapy (ART) discontinuation in a large multinational trial of early ART initiators. AIDS , 33 (8) pp. 1385-1390. 10.1097/QAD.0000000000002210. Green open access

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Abstract

OBJECTIVE: We aimed to investigate potential causes of higher risk of treatment interruptions within the multi-country START trial in 2015. METHODS: We defined baseline as the date of starting ART and a treatment interruption as discontinuing ART for ≥2 weeks. Participants were stratified by randomisation arm and followed from baseline to earliest of end date of the initial phase of START, death, date of consent withdrawn, or date of first treatment interruption. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals for factors that may predict treatment interruptions in each arm. RESULTS: Of the 3,438 participants who started ART, 2286 were in the immediate arm and 1152 in the deferred arm. 12.9% of people in the immediate arm and 10.5% of people in the deferred arm experienced ≥1 treatment interruption by 3 years after starting ART. In adjusted analyses, age (HR for 35-50 years: 0.75 (95% CI: 0.59, 0.97) and >50 years: 0.53 (0.33, 0.80) vs. < 35 years), education status (HR for post-graduate education vs. less than high-school education (0.23 (0.10, 0.50)) and region (HR for United States vs. Europe/Israel (3.16 (2.09, 4.77)) were significantly associated with treatment interruptions in the immediate arm. In the deferred arm, age and education status were significantly associated with treatment interruptions. CONCLUSION: Within START, we identified younger age and lower educational attainment as potential causes of ART interruption. There is a need to strengthen adherence advice and wider social support in younger people and those of lower education status.

Type: Article
Title: Risk factors for antiretroviral therapy (ART) discontinuation in a large multinational trial of early ART initiators
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000002210
Publisher version: https://doi.org/10.1097/QAD.0000000000002210
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: HIV, Interruption, ART, Treatment, Discontinuation
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10072208
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