{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:49:27Z","timestamp":1790495367490,"version":"4.1.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Antiviral Therapy"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The World Health Organization recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared with those who had treatment modifications after failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Treatment modification was defined as a change of two antiretrovirals, a drug class change or treatment interruption (TI), all for &gt;14 days. We assessed factors associated with CD4 changes and undetectable viral load (UVL &lt;1,000 copies\/ml) at 1 year after second-line failure using linear and logistic regression, respectively. Survival time was analysed using competing risk regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 328 patients who failed second-line ART in our cohorts, 208 (63%) had a subsequent treatment modification. Compared with those who continued the failing regimen, the average CD4 cell increase was higher in patients who had a modification without TI (difference =77.5, 95% CI 35.3, 119.7) while no difference was observed among those with TI (difference =-5.3, 95% CI -67.3, 56.8). Compared with those who continued the failing regimen, the odds of achieving UVL was lower in patients with TI (OR=0.18, 95% CI 0.06, 0.60) and similar among those who had a modification without TI (OR=1.97, 95% CI 0.95, 4.10), with proportions of UVL 60%, 22% and 75%, respectively. Survival time was not affected by treatment modifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CD4 cell improvements were observed in those who had treatment modification without TI compared with those on the failing regimen. When no other options are available, maintaining the same failing ART combination provided better VL control than interrupting treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3851\/imp3388","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T04:47:50Z","timestamp":1618202870000},"page":"377-387","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment Modification after Second-Line Failure among People Living with HIV in Asia-Pacific"],"prefix":"10.1177","volume":"25","author":[{"given":"Awachana","family":"Jiamsakul","sequence":"first","affiliation":[{"name":"The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iskandar","family":"Azwa","sequence":"additional","affiliation":[{"name":"University of Malaya Medical Centre, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fujie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Ditan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evy","family":"Yunihastuti","sequence":"additional","affiliation":[{"name":"Working Group on AIDS, Faculty of Medicine, University of Indonesia\/Cipto Mangunkusumo Hospital, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Ditangco","sequence":"additional","affiliation":[{"name":"Research Institute for Tropical Medicine, Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagalingeswaran","family":"Kumarasamy","sequence":"additional","affiliation":[{"name":"Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), The Voluntary Health Services (VHS), Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oon Tek","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jiun","family":"Chan","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penh Sun","family":"Ly","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Yong","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man-Po","family":"Lee","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Pujari","sequence":"additional","affiliation":[{"name":"Institute of Infectious Diseases, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasisopin","family":"Kiertiburanakul","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romanee","family":"Chaiwarith","sequence":"additional","affiliation":[{"name":"Research Institute for Health Sciences, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuti Parwati","family":"Merati","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashikala","family":"Sangle","sequence":"additional","affiliation":[{"name":"BJ Government Medical College and Sassoon General Hospital, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwimon","family":"Khusuwan","sequence":"additional","affiliation":[{"name":"Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict LH","family":"Sim","sequence":"additional","affiliation":[{"name":"Hospital Sungai Buloh, Sungai Buloh, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anchalee","family":"Avihingsanon","sequence":"additional","affiliation":[{"name":"HIV-NAT\/Thai Red Cross AIDS Research Centre, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuong Duy","family":"Do","sequence":"additional","affiliation":[{"name":"Bach Mai Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Tanuma","sequence":"additional","affiliation":[{"name":"National Center for Global Health and Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Ross","sequence":"additional","affiliation":[{"name":"TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Law","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the TREAT Asia HIV Observational Database of IeDEA Asia-Pacific","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"key":"bibr1-IMP3388","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy005"},{"key":"bibr2-IMP3388","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2017.1417527"},{"key":"bibr3-IMP3388","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v7.24861"},{"key":"bibr4-IMP3388","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328351f5b2"},{"key":"bibr5-IMP3388","unstructured":"World Health Organization. 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