• Login
    View Item 
    •   NRU
    • Journal Publications
    • Medical and Health Sciences
    • Medical and Health Sciences
    • View Item
    •   NRU
    • Journal Publications
    • Medical and Health Sciences
    • Medical and Health Sciences
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Incidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenya

    Thumbnail
    View/Open
    Article (281.7Kb)
    Date
    2014
    Author
    Inzaule, Seth
    Otieno, Juliana
    Kalyango, Joan
    Nafisa, Lillian
    Kabugo, Charles
    Nalusiba, Josephine
    Kwaro, Daniel
    Zeh, Clement
    Karamagi, Charles
    Metadata
    Show full item record
    Abstract
    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.
    URI
    https://nru.uncst.go.ug/xmlui/handle/123456789/1782
    Collections
    • Medical and Health Sciences [3670]

    Research Dissemination Platform copyright © since 2021  UNCST
    Contact Us | Send Feedback
    Partners
     

     

    Browse

    All of NRU
    Communities & CollectionsBy Issue DateAuthorsTitlesSubjects
    This Collection
    By Issue DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    View Usage Statistics

    Research Dissemination Platform copyright © since 2021  UNCST
    Contact Us | Send Feedback
    Partners