Determinants and reasons for switching anti-retroviral regimen among HIV-infected youth in a large township of South Africa (2002–2019)

Abstract

Background There are limited data exploring antiretroviral therapy (ART) changes and time to change among South Africa young people living with HIV/AIDS. Objective We describe the time to first drug switch, which includes ART regimen change (three drug switch) and substitutions (single drug switch). We describe common reasons for ART switch among young people aged 10 to 24 years in South Africa. Methods We conducted a retrospective cohort study at a primary health care clinic in Cape Town, South Africa, providing ART to HIV-infected adolescents and adults since 2002. Those aged 10 to 24 years at ART initiation, who accessed care clinic between September 2002 and April 2019. Data was retrieved from electronic information systems: ART regimens, ART changes, dates for initiation or stop of each drug/regimen, laboratory results (viral loads, haemoglobin, liver enzyme results, and creatinine to support the reason for ART switch. From written records, we abstracted reason for single drug switch or regimen change, as well as socio demographic and clinical data. We fitted cox regression models to determine factors associated with ART switch (Having a change in one or more drugs in ART combination) and the rate of occurrence. Results Of 2601 adolescents included, 605 (24.9%) adolescents switched ART over 5090.5 person years at risk (PYAR), a rate of 11.9 /100PYAR. Median follow-up time was 4.4 (± 3.2) years. At multivariable analysis, the older age group was protective of the risk of ART switch: adjusted Hazard Ratio [aHR] 0.78, 95% CI 0.62–0.98, transfer status [transferred out 1.42 [1.11–1.82]. The hazard of ART switch increased with more severe HIV-disease at ART start, as observed by increasing WHO clinical stage or reduced CD4 count at baseline. The primary reasons for ART switch were side effects (20.0%), virological failure (17.9%) and formulation switch (27.8%). Others reasons included pregnancy, Hepatitis B, tuberculosis and psychosis. Conclusion ART switches are frequent and occur at a consistent rate across 7.5 years from initiation. The main reasons for ART switch were virological failure and drug side effects.

Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa: a focus on surveillance

“…Indeed, the use of new therapeutic agents in combination with tenofovir (the most commonly used antiviral against HBV in PLWH) have less deleterious effect on steatosis and they are thought to potentially decrease risk of HCC by decreasing the risk of cirrhosis. Nonetheless, the specific effect of ART on HCC has not been well studied and many countries in Africa still use relatively older treatments which can increase the risk of liver dysfunction [ 23 , 34 ] .…”

“…An expected consequence of this, is the dramatically increased risk of developing complications from other associated chronic diseases, such as cirrhosis and HCC [32] . Patients on ART, on the other hand, have a higher risk of hepatotoxicity after starting the therapy [33] . Novel ART has decreased the toxic effect of these medications in the liver.…”

Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania

“…Studies have demonstrated that a strategic switch from one ART regimen to another can lead to a significant reduction in viral load, thereby enhancing treatment efficacy. By targeting distinct mechanisms of action and overcoming resistance pathways, ART switches offer a renewed opportunity to achieve and maintain the durable suppression of the virus [ 3 , 4 ].…”