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首页> 外文期刊>AIDS Research and Human Retroviruses >Incidence of modifying or discontinuing first HAART regimen and its determinants in a cohort of HIV-infected patients from Rio de Janeiro, Brazil.
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Incidence of modifying or discontinuing first HAART regimen and its determinants in a cohort of HIV-infected patients from Rio de Janeiro, Brazil.

机译：来自巴西里约热内卢的一组HIV感染患者中，修改或终止第一个HAART方案及其决定因素的发生率。

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Studies on the long-term safety and tolerability of HAART are scarce in developing countries. HAART has been universally available in Brazil since 1997, providing a unique opportunity to evaluate the incidence and risk factors for HAART discontinuation or modification. We analyzed retrospective data from 670 treatment-naive patients followed at the HIV cohort of Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil, who first received HAART between January 1996 and December 2006. Our four outcomes of interest were treatment failure (TF-MOD), short-term toxicity (ST-MOD), long-term toxicity (LT-MOD), and overall modification/discontinuation (MOD, composed of TF-MOD, ST-MOD, LT-MOD, and other reasons). Risk factors were assessed using Cox's proportional hazards regression. Incidences of MOD, ST-MOD, LT-MOD, and TF-MOD were 28.3, 24.0, 4.0, and 5.6 per 100 persons-years, respectively. MOD was observed in 69% of the patients; 40% of the MODs were toxicity related. The risk of MOD in the first year of treatment was 32% (95% CI: 28.3-35.5%); the median time from HAART initiation to MOD was 14 months (IQR: 3.0-29.5). The most frequent reasons for ST-MOD were gastrointestinal; women had a higher hazard for ST-MOD. Metabolic toxicity was the most frequent reason for LT- MOD, particularly dislipidemia and lipodystrophy. Increased hazard of TF-MOD was observed among those with lower CD4(+) lymphocyte counts (<200 cells/mm(3)). Our results indicate that toxicities can compromise adherence and thus impact future treatment options. This is especially relevant in the context of limited access to second and third line treatment regimens.
机译：在发展中国家，对HAART的长期安全性和耐受性的研究很少。自1997年以来，HAART已在巴西普遍使用，为评估HAART停用或修饰的发生率和危险因素提供了独特的机会。我们分析了在巴西里约热内卢奥斯瓦尔多·克鲁兹基金会Evandro Chagas临床研究所的HIV队列中研究的670例未接受过治疗的患者的回顾性数据，该研究队列于1996年1月至2006年12月首次接受HAART。治疗失败（TF-MOD），短期毒性（ST-MOD），长期毒性（LT-MOD）和整体修饰/停用（MOD，由TF-MOD，ST-MOD，LT-MOD组成，和其他原因）。使用Cox的比例风险回归评估风险因素。每100人年MOD，ST-MOD，LT-MOD和TF-MOD的发生率分别为28.3、24.0、4.0和5.6。在69％的患者中观察到MOD; 40％的MOD与毒性有关。治疗第一年发生MOD的风险为32％（95％CI：28.3-35.5％）;从HAART启动到MOD的中位时间为14个月（IQR：3.0-29.5）。 ST-MOD的最常见原因是胃肠道。妇女对ST-MOD的危害更大。代谢毒性是LT-MOD的最常见原因，尤其是血脂异常和脂肪营养不良。 CD4（+）淋巴细胞计数较低（<200细胞/ mm（3））的患者中，TF-MOD的危险性增加。我们的结果表明，毒性可能会损害依从性，从而影响未来的治疗选择。这在获得二线和三线治疗方案的机会有限的情况下尤其重要。

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