Demographic, socio-economic, behavioral and clinical factors predicting virologic failure with generic fixed-dose combination antiretroviral therapy before universal health insurance coverage in northern Thailand.

We conducted a 2-year prospective cohort study to investigate multiple aspects of factors predicting the outcome of fixed-dose combination antiretroviral (ARV) therapy with lamivudine, stavudine, and nevirapine (GPOvir) at a government referral hospital in northern Thailand. At 6 and 24 months after the initiation of GPOvir, viral load (VL) was measured to determine virologic failure (>400 RNA copies/ml) and demographic, socio-economic, behavioral and clinical data were collected. From 10 April 2002 to 31 January 2004, 409 patients participated in this study: 64/364 (17.0%) at 6 months and 55/345 (15%) at 24 months virologically failed treatment. On univariate analysis, besides ARV experience [odds ratio (OR), 3.08, 95% confidence interval (CI), 1.71 -5.57] and the frequency of delayed doses (OR, 2.97; 95% CI, 1.47-6.00), we identified one socioeconomic factor significantly associated with virologic failure: "not having child" (OR, 1.85; 95% CI, 1.03 - 3.34). Although the association with "not having child" became marginal on multivariate analysis, results of in-depth interviews and group discussions indicated that having a child was a strong motivating factor for good treatment compliance. We suggest that patients without children may need more attention. Further investigation of socio-economic factors is warranted.

Mortality analysis of HIV-1 infected patients for prioritizing antiretroviral drug therapy.

Mortality data of patients, classified according to their clinical status and CD4+ cell count status, would be very useful to guide clinicians to prioritizing patients who need antiretroviral drug therapy. In the current study, the authors re-analyzed data derived from a previously published retrospective study of HIV-1-infected individuals at Lampang Hospital in northern Thailand. According to the Cox proportional hazard model, compared to asymptomatic patients with a high CD4+ cell count (> 200 cell/microl), the mortality rate of asymptomatic patients with a medium CD4+ cell count (100-199 cell/microl) did not significantly differ. However, the mortality rate of patients with a CD4+ cell count below 100 cell/microl was at least 16 times higher, regardless of the presence of clinical symptoms. Based on these results, the authors produced a Lampang Hospital guideline of antiretroviral drug use; priority of antiretroviral therapy should, therefore, be given to patients with CD4+ cell count < 100 cell/microl.