Predictors of HIV virological failure and drug resistance in Chinese patients after 48 months of antiretroviral treatment, 2008–2012: a prospective cohort study
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    Response to Kan et al.
    • Yijia Li, Internal Medicine University of Pittsburgh School of Medicine

    Kan et al. nicely showed that in HIV-infected treatment-naïve first-line regimen initiators, four-year risk of virological failure (VF) and HIV drug resistance (HIVDR) were 11.8% and 5.0%, and they demonstrated that male and female participants had different risk factors for VF and HIVDR[1]. However, there are some limitations in this study that might be worth mentioning. First, in the inclusion phase, as the authors acknowledged, over half of the participants included in 2008 were lost to follow-up or excluded in 2012, which may generate selection bias. Hence, it would be important to compare the baseline characteristics in participants lost to follow-up/excluded and those who were included, in order to see whether there were any significant differences that may bias this study. Second, the authors did not account for baseline transmitted drug resistance mutation (DRM). Albeit rare, the prevalence of DRM was still 3% in treatment-naive participants in the year 2008, based on a meta-analysis[2]. As shown in a previous study in China with participants starting antiretroviral therapy (ART) between 2008-2010, baseline DRM is significantly associated with virological failure[3]. Coincidentally, this study found that HIVDR rate was 5.0%, comparable to the baseline DRM rate in the aforementioned meta-analysis. Thus, baseline DRM may actually affect HIVDR rate in this group of participants. Third, this study did not include men who have sex with men (MSM), which have become one o...

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    Conflict of Interest:
    None declared.