Incidence and predictors of first line antiretroviral regimen modification in western Kenya

Autor: Josephine Nalusiba, Seth C Inzaule, Daniel Kwaro, Lillian Nafisa, Clement Zeh, Joan N. Kalyango, Charles Kabugo, Charles Karamagi, Juliana A. Otieno
Rok vydání: 2013
Předmět:
Male
Viral Diseases
Epidemiology
lcsh:Medicine
HIV Infections
Global Health
Immunodeficiency Viruses
Risk Factors
Public and Occupational Health
lcsh:Science
Multidisciplinary
Antimicrobials
Incidence (epidemiology)
Incidence
Stavudine
Age Factors
HIV diagnosis and management
Antivirals
Infectious Diseases
Anti-Retroviral Agents
Medical Microbiology
HIV epidemiology
Research Design
Viral Pathogens
Cohort
symbols
Drug Therapy
Combination
Female
medicine.drug
Research Article
Adult
medicine.medical_specialty
Clinical Research Design
Research and Analysis Methods
Microbiology
symbols.namesake
Adverse Reactions
Internal medicine
Microbial Control
Virology
medicine
Humans
Poisson regression
Risk factor
Microbial Pathogens
Retrospective Studies
Medicine and health sciences
Pharmacology
business.industry
Proportional hazards model
Clinical epidemiology
lcsh:R
Biology and Life Sciences
HIV
Retrospective cohort study
Kenya
Diagnostic medicine
CD4 Lymphocyte Count
Regimen
Immunology
lcsh:Q
Clinical Medicine
business
Follow-Up Studies
Zdroj: PLoS ONE
PLoS ONE, Vol 9, Iss 4, p e93106 (2014)
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: