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

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dc.contributor.authorInzaule, Seth
dc.contributor.authorOtieno, Juliana
dc.contributor.authorKalyango, Joan
dc.contributor.authorNafisa, Lillian
dc.contributor.authorKabugo, Charles
dc.contributor.authorNalusiba, Josephine
dc.contributor.authorKwaro, Daniel
dc.contributor.authorZeh, Clement
dc.contributor.authorKaramagi, Charles
dc.date.accessioned2022-02-02T17:47:07Z
dc.date.available2022-02-02T17:47:07Z
dc.date.issued2014
dc.description.abstractLimited 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.en_US
dc.identifier.citationInzaule 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.0093106en_US
dc.identifier.other10.1371/journal.pone.0093106
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1782
dc.language.isoenen_US
dc.publisherPLoS ONEen_US
dc.subjectPredictorsen_US
dc.subjectFirst Line Antiretroviral Regimen Modificationen_US
dc.subjectWestern Kenyaen_US
dc.titleIncidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenyaen_US
dc.typeArticleen_US
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