Reasons for Regimen Change among HIV/AIDS Patients Initiated on First Line Highly Active Antiretroviral Therapy in Fitche Hospital, Oromia, Ethiopia

Assefa, Desta; Hussein, Nezif

doi:10.13189/app.2014.020502

Cited by 6 publications

(1 citation statement)

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“…The contradictory findings may be due to different populations, reasons for regimen change and stage of disease, for example, medication shortages and stockouts (35%), OIs (25%), side effects (20%) and treatment failure (19%) were the main reasons for regimen changes in the earlier study. In contrast, in previous Ethiopian studies, the most common reason for medication changes or switches were toxicity, comorbidity, patient compliance and treatment failure, which are similar to our findings 91 92…”

Section: Discussionsupporting

confidence: 88%

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

et al. 2022

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ObjectiveThis study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia’s Amhara Region.DesignWe conducted an institution-based retrospective follow-up study.SettingsThe study was conducted at Amhara Region’s comprehensive specialised hospitals in Ethiopia.ParticipantsWe included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020.Primary and secondary outcomesThe incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association.ResultsMore than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200–350 cells/mm3(aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98).ConclusionsOur study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.

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Section: Discussionsupporting

confidence: 88%

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

et al. 2022

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Incidence, predictors and reasons for initial regimen modifications in patients on antiretroviral therapy in Witbank, South Africa, 2003-2017

Musekiwa

et al. 2019

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BackgroundAntiretroviral therapy (ART) is associated with unpleasant adverse effects that may require modification of regimens. ART modifications may lead to poor treatment outcomes. We determined the incidence, reasons and predictors for modification of initial ART regimens.MethodsWe retrospectively analysed data from Witbank pharmacovigilance sentinel site, South Africa. Censoring targeted the first incident of ART modification from the initial regimen. We included human immunodeficiency virus (HIV)-infected patients on ART, aged more than 18 years. We used the Cox-proportional hazard model to identify predictors for changing initial ART regimens.ResultsAmong 2, 045 eligible patients, 38% (n=783) had their initial ART regimens changed. The overall incidence rate of ART modification was 10.0 per 100 person-years within a follow-up period of 7 794.6 person-years (PYs). Reasons for changing were adverse drug reactions (ADRs) (60%), prescriber’s decisions (37%), drug toxicity (26%) and treatment failure (12%). The most commonly changed regimens were stavudine (68%) and zidovudine (44%) based regimens. Stavudine-based regimen had the highest changing rate of 13.6 per 100 PYs compared to zidovudine (8.0 per 100 PYs) and tenofovir (6.5 per 100 PYs). Using tenofovir as reference, stavudine (aHR 2.3; 95% CI 1.8-2.9; p<0.001) and zidovudine (aHR 1.5; 95% CI 1.2-3.2; p<0.001) based regimens were significantly associated with regimen modifications. The predictors for changing ART regimens included drug toxicity (aHR 2.6; 95% CI 2.1-3.1), ADRs (aHR 2.1; 95% CI 1.3-3.2), treatment failure (aHR 2.0; 95% CI 1.5-2.4), baseline cd4 count of ≥200 (aHR 1.7; 95% CI 1.3-2.1) and initiation regimens (stavudine and zidovudine).ConclusionThe findings were suggestive of a moderate incidence of initial ART regimen changing. Patients on stavudine and zidovudine based regimens changed primarily due to ADRs and drug toxicity. We recommended that clinicians should consider changing patients who are still on stavudine-containing regimens, however, changing should be individualized.

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Multi-state models for the analysis of time-to-treatment modification among HIV patients under highly active antiretroviral therapy in Southwest Ethiopia

et al. 2017

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BackgroundHighly active antiretroviral therapy (HAART) has shown a dramatic change in controlling the burden of HIV/AIDS. However, the new challenge of HAART is to allow long-term sustainability. Toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. The aim of this study was to evaluate the durability of first line antiretroviral therapy and to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART.MethodsA Hospital based retrospective study was conducted from January 2007 to August 2013 at Jimma University Hospital, Southwest Ethiopia. Data on the prescribed ARV along with start date, switching date, and reason for change was collected. The primary outcome was defined as the time-to-treatment change. We adopted a multi-state survival modeling approach assuming each treatment regimen as state. We estimate the transition probability of patients to move from one regimen to another.ResultA total of 1284 ART naive patients were included in the study. Almost half of the patients (41.2%) changed their treatment during follow up for various reasons; 442 (34.4%) changed once and 86 (6.69%) changed more than once. Toxicity was the most common reason for treatment changes accounting for 48.94% of the changes, followed by comorbidity (New TB) 14.31%. The HAART combinations that were robust to treatment changes were tenofovir (TDF) + lamivudine (3TC)+ efavirenz (EFV), tenofovir + lamivudine (3TC) + nevirapine (NVP) and zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP) with 3.6%, 4.5% and 11% treatment changes, respectively.ConclusionMoving away from drugs with poor safety profiles, such as stavudine(d4T), could reduce modification rates and this would improve regimen tolerability, while preserving future treatment options.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2533-3) contains supplementary material, which is available to authorized users.

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Reasons for Regimen Change among HIV/AIDS Patients Initiated on First Line Highly Active Antiretroviral Therapy in Fitche Hospital, Oromia, Ethiopia

Cited by 6 publications

References 13 publications

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis

Incidence, predictors and reasons for initial regimen modifications in patients on antiretroviral therapy in Witbank, South Africa, 2003-2017

Multi-state models for the analysis of time-to-treatment modification among HIV patients under highly active antiretroviral therapy in Southwest Ethiopia

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