Incidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenya
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
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.
Description
Keywords
Predictors, First Line Antiretroviral Regimen Modification, Western Kenya
Citation
Inzaule S, Otieno J, Kalyango J, Nafisa L, Kabugo C, et al. (2014) Incidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenya. PLoS ONE 9(4): e93106. doi:10.1371/journal.pone.0093106