Characterizing Human Immunodeficiency Virus Antiretroviral Therapy Interruption and Resulting Disease Progression Using Population-Level Data in British Columbia, 1996-2015

Linwei Wang, Jeong Eun Min, Xiao Zang, Paul Sereda, Richard P. Harrigan, Julio S.G. Montaner, Bohdan Nosyk

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background Suboptimal retention is among the biggest challenges to realize the full benefits of combination antiretroviral therapy (ART). We aimed to describe ART interruption patterns and identify determinants of disease progression while off ART in British Columbia, Canada. Methods with population-level data on ART utilization and laboratory testing in British Columbia (1996-2015), we described the timing, frequency, and duration of ART interruptions (a gap of ≥90 days in ART dispensation records). A 4-state continuous-time Markov model was implemented to identify determinants of disease progression during individuals' first ART interruption episode. Disease progression was measured according to CD4-based state transitions (cells/μL: ≥500 to 200-499; 200-499 to <200; ≥500 to death; 200-499 to death; and <200 to death). Results Among individuals initiating ART, 3129 (38.6%) interrupted ART over a median 8-year follow-up (interquartile range [IQR], 4.3-13.5 years). Those interrupting ART had a median of 1 interruption (IQR, 1.0-3.0), with the first interruption occurring 12.8 (IQR, 4.0-36.1) months after ART initiation, lasting for 7.5 (IQR, 4.1-20.3) months. The proportion of individuals interrupting ART within the first year of ART initiation decreased over time; however, the absolute number of individuals interrupting ART remained high. In a multivariable analysis, age, historical plasma viral load, and ART regimen changes prior to interruption were associated with increased hazard of CD4 decline and death. Conclusions Our results demonstrate that ART interruptions are common even in a high-resource setting with universal free access to human immunodeficiency virus care. Further efforts are needed to promote ART reengagement and may consider prioritizing individuals with poorer prognostic factors.

Original languageEnglish (US)
Pages (from-to)1496-1503
Number of pages8
JournalClinical Infectious Diseases
Issue number9
StatePublished - Nov 1 2017
Externally publishedYes

Bibliographical note

Funding Information:
Financial support. This work was supported by the BC Ministry of Health–funded “Seek and Treat for Optimal Prevention of HIV & AIDS” pilot project; a grant from the National Institutes of Health (NIH)/National Institute on Drug Abuse (grant number R01-DA-041747); and by Genome Canada (142HIV), the Canadian Institutes of Health Research, Genome British Columbia, and Genome Quebec funding to P. R. H. and J. S. G. M. In addition, B. N. is supported by a Michael Smith Foundation for Health Research Scholar award.  Potential conflicts of interest. J. S. G. M. is supported with grants paid to his institution by the British Columbia Ministry of Health and by the NIH (R01-DA-036307). He has also received limited unrestricted funding, paid to his institution, from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Publisher Copyright:
© 2017 The Author. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.


  • antiretroviral therapy
  • CD4
  • disease progression
  • treatment retention


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