Details:

Alternative Title:
PLoS One
Publisher's site:
http://dx.doi.org/10.1371/journal.pone.0093106
Personal Author:
Inzaule, Seth ; Otieno, Juliana ; Kalyango, Joan ; Nafisa, Lillian ; Kabugo, Charles ; ... More +
Inzaule, Seth ; Otieno, Juliana ; Kalyango, Joan ; Nafisa, Lillian ; Kabugo, Charles ; Nalusiba, Josephine ; Kwaro, Daniel ; Zeh, Clement ; Karamagi, Charles Less -
Description:
Background

Limited antiretroviral treatment regimens in resource-limited settings require long-term sustainability of patients on the few available options. We evaluated the incidence and predictors of combined antiretroviral treatment (cART) modifications, in an outpatient cohort of 955 patients who initiated cART between January 2009 and January 2011 in western Kenya.

Methods

cART modification was defined as either first time single drug substitution or switch. Incidence rates were determined by Poisson regression and risk factor analysis assessed using multivariate Cox regression modeling.

Results

Over a median follow-up period of 10.7 months, 178 (18.7%) patients modified regimens (incidence rate (IR); 18.6 per 100 person years [95% CI: 16.2–21.8]). Toxicity was the most common cited reason (66.3%). In adjusted multivariate Cox piecewise regression model, WHO disease stage III/IV (aHR; 1.82, 95%CI: 1.25–2.66), stavudine (d4T) use (aHR; 2.21 95%CI: 1.49–3.30) and increase in age (aHR; 1.02, 95%CI: 1.0–1.04) were associated with increased risk of treatment modification within the first year post-cART. Zidovudine (AZT) and tenofovir (TDF) use had a reduced risk for modification (aHR; 0.60 95%CI: 0.38–0.96 and aHR; 0.51 95%CI: 0.29–0.91 respectively). Beyond one year of treatment, d4T use (aHR; 2.75, 95% CI: 1.25–6.05), baseline CD4 counts ≤350 cells/mm3 (aHR; 2.45, 95%CI: 1.14–5.26), increase in age (aHR; 1.05 95%CI: 1.02–1.07) and high baseline weight >60kg aHR; 2.69 95% CI: 1.58–4.59) were associated with risk of cART modification.

Conclusions

Early treatment initiation at higher CD4 counts and avoiding d4T use may reduce treatment modification and subsequently improve sustainability of patients on the available limited options.


Subject:
[+]
Adult
Age Factors
Anti-Retroviral Agents
CD4 Lymphocyte Count
Drug Therapy, Combination
Female
Follow-Up Studies
HIV Infections
Humans
Incidence
Male
Research Article
Retrospective Studies
Risk Factors

Source:
PLoS One. 2014; 9(4).
Document Type:
Journal Article
Funding:
087540/Wellcome Trust/United Kingdom
Place as Subject:
Kenya
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:463b9df30a52d2ed45da1da74fade7aa96dc435833f33e83233d88d8a36313cc
File Type:

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