Dissertations / Theses on the topic 'Switch failures'

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1

Velagapudi, Alekhya. "Time Series Event Analysis of Pooled Multiyear Telecommunication Outages." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1470824497.

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2

Sullivan, John F. "Network fault tolerance system." Link to electronic thesis, 2000. http://www.wpi.edu/Pubs/ETD/Available/etd-0501100-125656.

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3

Mhangwane, Shushu Rirhandzu Comfort. "Predicting early and late first-line antiretroviral therapy virologic failure, and switch to second-line therapy in a military population in South Africa." Diss., University of Pretoria, 2018. http://hdl.handle.net/2263/64177.

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The study involved retrospective data analysis using statistical methods to re-analyse data collected during a long-term study in a Human Immunodeficiency Virus infected population of South African National Defence Force employees and their dependents, where different parameters related to treatment and disease status of HIV infected patients were collected. This study attempted to identify possible predictors of both early and late occurrence of first-line antiretroviral therapy virologic failure, potential predictors of first-line antiretroviral virologic failure and for switching to second line therapy were identified.
Dissertation (MSc)--University of Pretoria, 2018.
HJF- Phidisa project
Pharmacology
MSc
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4

Kobza, John E. "The significance of transients following failures and repairs in packet-switched networks." Diss., Virginia Tech, 1993. http://hdl.handle.net/10919/40098.

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A system composed of unreliable components can experience different levels of performance as its configuration changes due to failures and repairs. One approach used to measure overall system performance is to weight the level of performance measured for each system state by the probability that the system is in that state and then sum across all system states. Many performance measures have a transient behavior following a change in the state of the system. Because of the difficulty associated with transient analysis, the system is often assumed to be in steady state when measuring the performance for each system state. When this approach is used to analyze packet-switched communication networks, which consist of highly reliable high-speed links and switching nodes, it is argued that the steady-state assumption is justified on the basis of the large difference in rates of traffic-related events, such as call completions and packet transmissions, compared to component-related events, such as failures and repairs. To investigate the validity of this assumption, we define lower bounds for the length of the transient phase fol1owing link failures and repairs. For both cases, we obtain a distribution for the length of the lower bound. The transient phase is significant when its length exceeds a given fraction of the time until the next change in network state. Using the distributions for these lengths, we derive an expression for the probability that the transient phase is significant in terms of the amount of traffic on the link and the ratio of the rates for traffic-related events and network state changes. These results show that the difference in rates between traffic-related events and component related events is not enough by itself to justify the steady-state assumption. The amount of traffic carried on the link and the size of the network must also be considered. These results indicate some situations where the steady-state assumption is inappropriate. We also obtain sufficient conditions for transient-phase significance following link failures. Although these results do not indicate when it is safe to use the steady-state assumption, they provide a measure of the risk associated with using it.
Ph. D.
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Jalili, Hassankiadeh Seyedahmad. "Failure analysis of railway switches and crossings for the purpose of preventive maintenance." Thesis, KTH, Transportvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-52614.

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In the Swedish railway network there are about 12000 units of track switches and crossings, which at 13000 Km, make up about 5.5 percent of the total track length. However, the maintenance cost for S&C is more than 13 percent of the total maintenance cost which is high in comparison with their proportion. The aim of the project is to conduct research into classification of the different modes of failure in S&C components and to perform a statistical analysis to converge the data in order to determine the most important failures that occur in turnouts.
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6

Luedtke, Elin. "Minimizing Transformer No-Load Losses at Hydropower Plants : A Study of Effects from Transformer Switch-Off During Stand-by Operation." Thesis, Uppsala universitet, Institutionen för fysik och astronomi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-447635.

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Hydropower is the most important power balancing resource in the Swedish electrical power system, regulating the power supply to match the load. Consequently, several hydropower plants have periods of stand-by operation where the power production is absent but where several devices within a plant are still active. Such a device is the step-up power transformer, which during stand-by operation still generates no-load energy losses. These losses can accumulate to a considerable amount of energy and costs during the long technical lifetime of the apparatus. One option to minimize these no-load energy losses is by turning the transformer off when its generating unit is in stand-by operation. However, when this transformer operational change has been explained to experts in the field, the most common response has been that a more frequent reenergizing of a transformer leads to higher risks for errors or transformer breakdowns. This study aimed to analytically investigate three effects from this operational change. First, the potential of fatigue failure for the windings due to the increased sequences of inrush current. Secondly, the thermal cycling as a consequence of change in present losses. Lastly, the energy and economic saving potentials for hydropower plants where this operational adjustment is applied. The study used both established as well as analytical tools explicitly created for this study. These were then applied on currently active transformers in different plant categories in Fortum’s hydropower fleet.  The study primarily showed three things. Firstly, risk of fatigue failure due to the increased presence of inrush currents did not affect the transformer’s technical lifetime. Secondly, the thermal cycling changes were slightly larger with absent no-load losses during stand-by operation. The average temperature for the transformer decreased, which in general is seen as a positive indicator for a longer insulation lifetime and thus the transformer’s technical lifetime. Finally, the created frameworks showed the potential of saving energy and money for all plant categories, where the potential grew with the installed production capacity and the stand-by operation timeshare. Despite the simplifications made to describe the complex reality of a transformer operating in a hydropower plant, this thesis contributes to lay a foundation for future investigation of an easy adjustment to avoid unnecessary energy losses and costs for transformers in hydropower plants.
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7

Sack, Michael N. "The energy substrate switch during cardiac development, with the onset of cardiac hypertrophy and the transition to heart failure. : delineation and characterisation of gene regulatory mechanisms : "changing concepts of metabolic regulation in the h." Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/3457.

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8

Dou, Zhifeng. "Sûreté de fonctionnement des convertisseurs - Nouvelles structures de redondances pour onduleurs sécurisés à tolérance de pannes." Thesis, Toulouse, INPT, 2011. http://www.theses.fr/2011INPT0096/document.

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Au sein d'un convertisseur la défaillance d'un composant de puissance est un événement critique tant par le risque d'explosion du boitier et sa propagation au sein du système (forte énergie stockée dans l'alimentation) que par l'interruption de service qui en découle (systèmes embarqués, systèmes de production en flux tendu). Ce mémoire de thèse propose un ensemble de solutions nouvelles portant sur la problématique de l'isolement ultime de défauts "derniers secours" d'une part, et sur la connexion "automatique" et à faible "coût" d'un circuit en secours. L'objectif de cette approche globale est de concilier "sécurité électrique absolue" et "continuité de service" pour les systèmes de conversion sensibles devant être intégrés au coeur des applications critiques. Le premier chapitre et son annexe permettent de rappeler les causes et les conséquences des défauts internes au sein d'une structure de base d'onduleur à deux niveaux de tension, laquelle fait l'objet de nombreuses simulations de modes dégradés en configuration variateur de vitesse sur machine synchrone. De cette analyse il ressort qu'une structure d'isolement symétrique à deux voies couplées, placées sur les pôles du bus DC, à déclenchement spontané (fusible) et/ou commande (rupteur), est à même de sécuriser toutes les mailles du circuit, de façon modulaire et non intrusive
In all these traditional industries, or in more sensitive sectors and high technology, it appears that the safe operation of power systems becomes a critical and strategic area essential. In the area of application that focuses, design dependability and now rests primarily on an approach to reliability of components used, the use of close protection, monitoring alarms and management stop / reset / recovery. In our view, this approach is incomplete quickly when electrical safety and absolute continuity of a permanent mission should be carried out simultaneously in the presence of an internal failure of sensitive functions for low and medium power (eg, orders and bodies actuation of vehicles) or highly critical (nuclear). In this area, topologies and failure modes are at the heart of the problem. In this paper, we will focus primarily on the inverters and choppers structures at two levels of voltage (single-cell arm, <1kV), with simple configuration and multiphase parallel, although the concepts are presented, as examples, partially extrapolated to the structures of three voltage levels (arms multicellular) and rectifier (low-frequency phase control and high-frequency switching PWM). We will highlight the need to limit the intensity of these failures and to electrically isolate the defective cell and symmetrically of this inverter by multipole devices, passive or spontaneous breaking mixed cut ordered in the form of fuses integrated and distributed of multi-channel passive isolators, to imagine and develop. We will show that this process of isolation of the last backup is needed to connect, form series or parallel to the defective cell, a cell rescue in passive redundancy. The cell structure backup connection pooled by spontaneous (automatic) is especially promising as detailed in our eyes because of its simplicity and its integrability. Next, we present the isolation technologies fuse (not included, miniatures, CMS and multilayer chip fuse), their characteristics, their current limitations and operating in a switching cell test. A methodology and design of symmetrical two-way fuse (dual-fuse) on FR4 PCB - Copper will be presented in Comsol ™ and evaluated initially in static thermal IR. A passive two-way switch, relatively original material for integrating energy embedded in FR4 substrate, will be presented and fully dimensioned plans on electrical, thermal and mechanical also using finite element simulations in Comsol ™. Another aspect of exploratory analysis, mainly experimental, or to characterize the failure modes of bullets and casings ultimate power compared between the technologies of encapsulation by epoxy resin (standard discrete case) and a silicone gel (module) is provided under conditions of stress controlled and reproducible. This step is necessary to characterize the resistive mode of a chip based on faulty stresses and stability over time of the residual strength according to the nature of the encapsulant, ie the very sustainability of this failure mode. A mixed-encapsulant resin - gel will be presented and characterized, providing an excellent compromise for medium power applications. Positive results and little known today, will allow us to exploit in the next chapter, this property of stable ohmic mode of the chip failed in a structure to aid automated connection series interesting. In the end, we will detail the demonstrator prototype and introduced to the context with which we will validate the isolation structures and prototypes fuses the property of stable ohmic mode highlighted in the aspect of technological analysis of selected devices. These results allow us to refine the solutions adopted for specifications and guide future management strategy of defects whether internal or external to the topology. Supervisor digital device - sensor for the detection and reconfiguration of internal control orders will be assessed
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9

Soares, Nielson. "Técnicas de aprendizado de máquina não supervisionado para a prevenção de falhas em máquinas de chave." Universidade Federal de Juiz de Fora (UFJF), 2018. https://repositorio.ufjf.br/jspui/handle/ufjf/6513.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
As máquinas de chave são equipamentos eletromecânicos de grande importância em uma malha ferroviária. A ocorrência de falhas nesses equipamentos pode ocasionar interrupções das ferrovias e acarretar potenciais prejuízos econômicos. Assim, um diagnóstico precoce dessas falhas pode representar uma redução de custos e um aumento de produtividade. Essa dissertação tem como objetivo propor um modelo preditivo, baseado em técnicas de inteligência computacional, para a solução desse problema. A metodologia aplicada compreende o uso de técnicas de extração e seleção de características baseada em testes de hipóteses e modelos de aprendizado de máquina não supervisionado. O modelo proposto foi testado em uma base de dados disponibilizada por uma empresa ferroviária brasileira e se mostrou eficiente ao constatar como críticas as operações realizadas próximas à operação classificada como falha.
Railroad switch machines are important electromechanical equipment in a railway network, and the occurrence of failures in such equipment can cause railroad interruptions and lead to potential economic losses. Thus, an early diagnosis of these failures can represent a reduction of costs and an increase in productivity. This dissertation aims to propose a predictive model, based on computational intelligence techniques, to solve this problem. The applied methodology includes the use of features extraction and selection techniques based on hypothesis tests and unsupervised machine learning models. The proposed model was tested in a database made available by a Brazilian railway company and proved to be efficient when considering as critical the operations performed close to the operation classified as failure.
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10

Woolston, C. P. "A method of increasing capacity of an electricity distribution network through predictive modelling and intelligent protection." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36121/1/36121_Woolston_2000.pdf.

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This thesis describes the development of a software system which was implemented by the South East Queensland Electricity Board Australia (SEQEB). The software uses temperature probes and mathematical modelling to continuously determine maximum current carrying capacity of underground feeders. It identifies other plant capable of modelling (such as Transformers) and develops a higher level software architecture for which models may be integrated and with which automated overload verification and plant protection may be achieved. The usefulness of this software is that it permits higher currents than usual to be conveyed along cables and allows SEQEB to provide less cabling and still provide the same amount of power, achieving cost benefits. The new software runs over the existing Supervisory Control and Data Acquisition system (SCADA) and because of this, the thesis carries out an appraisal of several commercial SCADA products. This thesis describes the development of the cable-modelling algorithm, the higher level software architecture and describes the design, development and commissioning of this software within South East Electricity Boards' Supervisory Control and Data Acquisition System.
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11

Niu, Shiqin. "Conception, optimisation et caractérisation d’un transistor à effet de champ haute tension en Carbure de Silicium." Thesis, Lyon, 2016. http://www.theses.fr/2016LYSEI136/document.

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La thèse intitulée "Conception, caractérisation et optimisation d’un transistor à effet de champ haute tension en Carbure de Silicium (SiC) et de leur diode associée", s’est déroulée au sein du laboratoire AMPERE sous la direction du Prof. D. PLANSON. Des premiers démonstrateurs de JFET ont été réalisés. Le blocage du JFET n'est pas efficace, ceci étant lié aux difficultés de réalisation technologique. Le premier travail a consisté en leur caractérisation précise puis en leur simulation, en tenant compte des erreurs de processus de fabrication. Ensuite, un nouveau masque a été dessiné en tenant en compte des problèmes technologiques identifiés. Les performances électriques de la nouvelle génération du composant ont ainsi démontré une amélioration importante au niveau de la tenue en tension. Dans le même temps, de nouveaux problèmes se sont révélés, qu’il sera nécessaire de résoudre dans le cadre de travaux futurs. Par ailleurs, les aspects de tenue en court-circuit des JFETs en SiC commercialement disponibles ont été étudiés finement. Les simulations électrothermiques par TCAD ont révélé les modes de défaillances. Ceci a permis d'établir finalement des modèles physiques valables pour les JFETs en SiC
Silicon carbide (SiC) has higher critical electric field for breakdown and lower intrinsic carrier concentration than silicon, which are very attractive for high power and high temperature power electric applications. In this thesis, a new 3.3kV/20A SiC-4H JFET is designed and fabricated for motor drive (330kW). This breakdown voltage is beyond the state of art of the commercial unipolar SiC devices. The first characterization shows that the breakdown voltage is lower (2.5kV) than its theoretical value. Also the on-state resistance is more important than expected. By means of finite element simulation the origins of the failure are identified and then verified by optical analysis. Hence, a new layout is designed followed by a new generation of SiC-4H JFET is fabricated. Test results show the 3.3kV JFET is developed successfully. Meanwhile, the electro-thermal mechanism in the SiC JFETs under short circuit is studied by means of TCAD simulation. The commercial 1200V SIT (USCi) and LV-JFET (Infineon) are used as sample. A hotspot inside the structures is observed. And the impact the bulk thickness and the canal doping on the short circuit capability of the devices are shown. The physical models validated by this study will be used on our 3.3kV once it is packaged
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Melle, Samuel. "Analyse et modélisation des phénomènes de chargement de diélectriques dans les MEMS RF : application à la fiabilité prédictive de micro-commutateurs électromécaniques micro-ondes." Phd thesis, Université Paul Sabatier - Toulouse III, 2005. http://tel.archives-ouvertes.fr/tel-00011359.

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Ces dernières années ont vu l'émergence de nouveaux composants micro-ondes, les micro-commutateurs MEMS RF, possédant des performances très attrayantes pour de nombreux domaines d'application : spatial, automobile, téléphonie mobile& Cependant, une problématique majeure retarde actuellement leur industrialisation : leur fiabilité. Ce manuscrit de thèse a pour but principal de mettre en place les procédures d'investigation de la fiabilité des MEMS RF comprenant le développement des outils matériels et méthodologiques permettant d'analyser et de modéliser les phénomènes régissant la fiabilité de ces composants. Le premier chapitre effectue un état de l'art critique des bancs de tests et des résultats publiés par les laboratoires internationaux travaillant sur la fiabilité des MEMS RF. Le second chapitre détaille le banc de fiabilité développé dans le cadre de nos travaux. Nous présentons les différentes parties le constituant ainsi que les mesures des propriétés des MEMS RF qu'elles permettent d'effectuer en vue d'analyser leur fiabilité. Le troisième chapitre se focalise sur la méthodologie mise en place en vue d'étudier la fiabilité des micro-commutateurs capacitifs. Cette méthodologie est basée sur la détection et l'analyse des modes de défaillance d'une part et sur la modélisation du mécanisme de défaillance d'autre part. Nous proposons ainsi un modèle du chargement du diélectrique, principale cause de défaillance de ce type de composants, et introduisons un facteur de mérite de la fiabilité des MEMS RF permettant une évaluation comparative de leur durée de vie. Dans un quatrième chapitre, nous présentons les trois axes de recherche sur lesquels des études préliminaires ont été effectuées en vue d'améliorer la fiabilité des MEMS RF capacitifs : l'optimisation technologique, l'optimisation de la commande et l'optimisation de la topologie des micro-commutateurs
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Hsueh, Yen Hsien, and 薛彥賢. "Factors that Cause New Product Failures in a SME: A Case Study of Multifunction Light Switch." Thesis, 2019. http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/login?o=dnclcdr&s=id=%22107CGU05627019%22.&searchmode=basic.

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14

Chiang, Wen-Ping, and 江文平. "Benefit Analysis of Distribution Automation Switches Applied to the System Failure Handling." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/87084111500047959891.

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碩士
國立彰化師範大學
電機工程學系
101
Recently, with highly Taiwan's industrial development, the requirement for power quality and reliability is getting more stringent. Taiwan Power Company has thus been employing distribution automation switch system to actively enhance the restoration efficiency to improve power supply reliability and power quality increasing customer satisfaction and reducing losses. This paper introduces the distribution automation switching system architecture and their existing types, and briefly explains communication systems. With employing the least squares method to predict the optimal load distribution; the fault detection function can effectively reduce the power failure area, shorten power restoration time. In addition, by analyzing the quantitative data related to operations of the restoration capacity and quality of power supply, the benefits of installing distribution automation switching system is ascertained. The number of feeder trips can only be achieved with partial effectiveness for the factors of nature disturbance (thunder harm, typhoons, etc.); thus, its improvement can be further studied.
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Poboka, Dane Michael. "Preparation, interference and task switching: using distributional analysis and cognitive modelling estimates to extend the FTE theory." Thesis, 2017. http://hdl.handle.net/1959.13/1335830.

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Research Doctorate - Doctor of Philosophy (PhD)
For more than two decades, the processes involved in task switching have been extensively investigated and numerous theories proposed attempting to explain task switch phenomena, such as switch costs, preparation effects and residual switch costs (Grange & Houghton, 2014b). A range of experimental paradigms have been employed to demonstrate the key factors that influence performance; from endogenous mechanisms related to cognitive control and executive functioning, through to task priming, interference and decay processes. I begin this thesis by providing an overview of significant task switch theories, paradigms and findings to illustrate the breadth of existing task switch research. Following this, I present a series of experiments that employ distributional analysis to investigate anticipatory preparation and proactive interference effects on task switch performance. The experiments lead to the proposal of a descriptive, activation driven model of performance, which is tested using specific experimental manipulations. The results indicate the importance of design parameters and how these can affect responding based on strategic and structural task switch related processes. Finally, I investigate the Failure to Engage (FTE) account of residual switch costs (De Jong, 2000) and replicate research that challenges this theory (Brown, Lehmann & Poboka, 2006). The results guided an extension of FTE that was tested in a further experiment and shown to be able to accommodate the effects of interval manipulations as well as both task and cue switching. I then apply a new modelling approach to obtain direct estimates of the probability of preparation and conclude that De Jong’s insights about preparation failure provide a tractable framework for understanding many aspects of cognitive control, including explaining aspects of all of the four major task-switching phenomena identified by Monsell (2003).
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SANGARÉ, Mohamed Ndongo. "Cohorte de patients vivant avec le VIH et ayant de la résistance prouvée ou présumée : analyse des changements de traitement pour une trithérapie contenant deux inhibiteurs nucléosidiques de la transcriptase inverse (INTI) avec du dolutégravir ou du ténofovir/abacavir avec un troisième agent." Thesis, 2020. http://hdl.handle.net/1866/25537.

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Des progrès importants ont été réalisés dans la thérapie des personnes vivant avec le VIH (PVVIH) avec le développement d’antirétroviraux (ARV) de plus en plus efficaces, sûrs avec une bonne innocuité et tolérance. Cependant, des défis thérapeutiques demeurent chez les PVVIH dont le VIH pourrait être porteur de mutations génétiques conférant de la résistance aux traitements soit en raison d’une histoire d’échec thérapeutique antérieur soit en raison d’une exposition antérieure à une mono/bithérapie aux inhibiteurs nucléosidiques de la transcriptase inverse (INTI) (thérapie sous-optimale qui se faisait avant l’ère des trithérapies). Chez ces patients, les cliniciens peuvent tenter des combinaisons peu étudiées dans l’espoir de mieux contrôler la charge virale ou de réduire les effets secondaires. Ainsi, cette thèse par articles avait trois objectifs qui visaient à étudier des thérapies utilisées chez ces patients mais pour lesquelles il y a peu ou pas de données. Le premier objectif (article 1) consistait à déterminer si l'efficacité du régime ARV avec dolutégravir chez les patients stables (dont la charge virale est supprimée) variait en présence d'une histoire d’échec virologique ou d’exposition antérieure à la thérapie sous-optimale. Le deuxième objectif (article 2) visait à comparer l’issue virologique des PVVIH stables ayant un échec virologique documenté ou une exposition antérieure à la thérapie sous-optimale et qui ont maintenu leur régime inhibiteur de la protéase/ritonavir (IP/r) par rapport à ceux qui sont passés au dolutégravir. Finalement, le troisième objectif (article 3) était de comparer le risque d’échec virologique chez les PVVIH avec une histoire d’échec virologique ou de thérapie sous-optimale prenant un traitement non standard d’ARV composé d’abacavir/ténofovir disoproxil (ABC/TDF) avec un 3e ARV d’une classe différente par rapport à un régime composé d’un traitement de fond standard. Nous avons utilisé les données de la cohorte VIH du Québec qui regroupe 10 219 PVVIH suivies au niveau de quatre centres à Montréal incluant la Clinique de médecine urbaine du Quartier Latin (CMUQL), la Clinique médicale l’Actuel (CMA), le Centre hospitalier universitaire de Montréal (CHUM) et le Centre universitaire de santé McGill (CUSM). Une restriction à certains patients a été réalisée pour chacun des objectifs. Les patients avec une charge virale indétectable qui avaient reçu une thérapie avec dolutégravir + 2 INTI à partir de 2013 ont été retenus pour l’objectif 1. Le modèle de risque proportionnel de Cox avec score de propension a été utilisé afin de comparer l’issue virologique des patients sous dolutégravir en fonction de l’exposition étudiée. Pour l’objectif 2, les patients stables avec une histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale qui étaient sous IP/r + 2 INTI à partir de 2014 ont été sélectionnés. Le modèle de Cox structurel marginal a permis de voir l’effet du changement de traitement vers le dolutégravir + 2 INTI en comparaison avec ceux qui sont restés sur IP/r + 2 INTI. Pour l’objectif 3, les patients avec une histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale qui étaient sous traitements de fond standards (abacavir/lamivudine, ténofovir disoproxil/emtricitabine, ténofovir disoproxil/lamivudine) avec un agent autre qu’un INTI à partir du 1er janvier 2006 ont été retenus. Le modèle multivarié proportionnel de Cox a été utilisé afin de comparer l’issue virologique des patients passés à un régime de thérapie inhabituelle à base d’ABC/TDF par rapport à ceux qui sont restés sur traitement de fond standard. L’article 1 a montré une efficacité similaire du dolutégravir chez les patients stables avec ou sans histoire d’échec virologique documenté ou d’exposition à une thérapie sous-optimale (Hazard ratio ajusté (HRa)=0,84 (IC95% : 0,35 - 2,01)). Dans l’article 2, aucune preuve d'un risque accru d'échec virologique n’a été trouvée chez les patients stables ayant déjà eu un échec virologique antérieur ou une exposition à une thérapie sous-optimale qui ont eu un changement de régime vers le dolutégravir en comparaison avec ceux qui ont maintenu leur régime IP/r (HRa=0,57 (IC95% : 0,21 - 1,52)). Dans l’article 3, une réduction non significative du risque d’échec virologique avec le traitement de fond non standard à base d’ABC/TDF a été trouvée par rapport au traitement de fond standard (HRa=0,45 (IC95% : 0,06 - 3,36)). En conclusion, les résultats de cette thèse n’ont pas montré un effet de la présence d’échec virologique antérieur ou d’exposition à une thérapie sous-optimale sur l’efficacité du dolutégravir. Par ailleurs, les résultats ont permis de constater que le changement vers le dolutégravir + 2 INTI pour des patients stables sur un régime IP/r + 2 INTI peut être envisagé malgré la présence ou la suspicion de mutation de résistance aux INTI. Ces résultats sont importants puisqu’ils devraient permettre de faire changer les guides cliniques concernant le dolutégravir chez les patients stables. Par contre, nos résultats n’ont pas réussi à montrer un avantage significatif à utiliser le traitement de fond à base d’ABC/TDF en comparaison au traitement de fond standard chez des patients présentant une histoire d’échec virologique ou d’exposition à la thérapie sous-optimale.
Significant progress has been made in treatment for people living with HIV (PLHIV) with the development of increasingly effective antiretroviral (ARV) therapy, safe with good tolerability. However, clinicians can sometimes face treatment challenges related to the monitoring of PLHIV whose HIV could carry genetic mutations conferring resistance to treatments either because of a history of virologic failure or because of previous exposure to mono/bitherapy to nucleoside reverse transcriptase inhibitors (NRTIs) (suboptimal therapy that was provided before the era of triple therapy). In these patients, clinicians can sometimes try less studied combinations in the hopes to better control viral load or reduce side effects in these patients. Therefore, this thesis by articles had three objectives aiming to evaluate less studied therapies that are used in these patients. The first objective (Paper 1) was to determine whether the efficacy of ARV regimen with dolutegravir in stable patients (whose viral load is controlled) varied in the presence of a history of virologic failure or with a previous exposure to suboptimal therapy regimen. The second objective (Paper 2) was to study virologic outcome after switching to dolutegravir compared to remaining on a boosted protease inhibitor (PI/r) regimen in stables PLHIV with prior documented virologic failure or exposure to mono/dual NRTI. Finally, the third objective (Paper 3) was to compare the risk of virologic failure for PLHIV who have previous documented virologic failure or prior exposure to suboptimal therapy taking an ARV therapy composed of abacavir/tenofovor (ABC/TDF) with a third agent of a different class, versus an ARV regimen composed of a standard backbone also with a non-NRTI third agent. We used data from the Quebec HIV cohort which brings together clinical information from 10,219 PLHIV followed in four clinical care centers in Montreal including the “Clinique de médecine urbaine du Quartier Latin (CMUQL)”, “Clinique médicale l’Actuel (CMA)”, the “Centre hospitalier de l'Université de Montréal (CHUM)” and the “McGill University Health Center (MUHC)”. A restriction to some patients in the cohort was made with regards to each objective of this thesis. Patients with an undetectable viral load who had received therapy with dolutegravir +2 NRTI from 2013 were selected for the objective 1. A Cox proportional hazard model with propensity score was used to compare the virologic outcome of patients on dolutegravir according to the exposure. For objective 2, patients with an undetectable viral load with an history of documented virologic failure or exposure to suboptimal therapy who were on PI/r + 2 NRTI from 2014 were selected. A marginal structural Cox model was used to measure the effect of switching to dolutegravir +2 NRTI compared to those who remained on PI/r + 2 NRTI therapy. For objective 3, patients with a documented virologic failure or exposure to suboptimal therapy in standard backbone (abacavir/lamivudine, tenofovir disoproxil/emtricitabine, tenofovir disoproxil/lamivudine) with another agent from January 01, 2006 were selected. A Cox proportional multivariate model was used to compare the virologic outcome of patients who switched to a non-standard regimen including ABC/TDF therapy versus those who remained on standard backbone. The article 1 suggested similar virologic efficacy of dolutegravir in stables patients with or without an history of documented virologic failure or exposure to suboptimal therapy (adjusted Hazard Ratio (aHR)=0,84 (95%CI: 0,35 - 2,01)). In article 2, no evidence of an increased risk of virologic failure was found in stables patients who had a regimen switched to dolutegravir compared to those who maintained their regimen with PI/r in patients who have had previous virologic failure or exposure to suboptimal therapy (aHR=0,57 (95%CI: 0,21 - 1,52)). In article 3, a non-significant reduction in the risk of virologic failure with the non-standard backbone including ABC/TDF was found compared to standard backbone (aHR=0,45 (95%CI: 0,06 - 3,36)). In conclusion, the results of this thesis first suggested no effect of the presence of previous virologic failure or exposure to suboptimal therapy on the efficacy of dolutegravir in stables patients. In addition, the results showed that the switch to dolutegravir +2 NRTI for patients with an undetectable viral load on PI/r +2NRTI regimen can be considered despite the presence of proved or suspected NRTI resistance mutation. These results are of great importance as they should lead to changes the clinical guidelines for the use of dolutegravir in stable patients. On the other hand, our results failed to show a significant advantage to the use of the backbone ABC/TDF instead of standard backbones in patients with prior documented virologic failure or previous exposure to suboptimal therapy.
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