Antiretroviral treatment changes in adults from Côte d'Ivoire: the roles of tuberculosis and pregnancy

Abstract

Objective To determine the rates and causes of first antiretroviral treatment (ART) changes in HIV-infected adults in Côte d'Ivoire. Methods We evaluated adults who initiated ART in an outpatient clinic in Abidjan. We recorded baseline and follow-up data, including drug prescriptions and reasons for changing to alternative first-line regimens (drug substitution for any reason but failure) or second-line regimens (switch for failure). Results 2012 HIV-infected adults (73% women) initiated ART. At baseline, 9% of all patients were on treatment for tuberculosis and 3% of women were pregnant. First-line ART consisted of 2 NRTIs (58% stavudine-lamivudine, 42% zidovudine-lamivudine) and efavirenz (63%), nevirapine (32%) or indinavir (5%). Median follow-up time was 16.9 months. During this time, 205 (10%) patients died and 261 (13%) were lost to follow-up. Overall, the rate of treatment modifications was 20.7/100 patient-years (PY). The most common modifications were drug substitutions for intolerance (12.4/100PY), pregnancy (4.5/100PY) and tuberculosis (2.5/100PY). The rates of intolerance-related substitutions were 17.9/100PY for stavudine, 6.3/100PY for nevirapine, 3.9/100PY for zidovudine and 0.1/100PY for efavirenz. Twenty percent of efavirenz substitutions resulted from pregnancy and 18% of nevirapine substitutions were related to tuberculosis treatment. Conclusions During the first months following ART initiation, a third of all treatment changes occurred for reasons other than intolerance to the drug or treatment failure. In Africa, drug forecasting is crucial to ensuring the success of HIV treatment programs. Drugs that do not require interruptions during pregnancy or tuberculosis treatment should be made more readily available as first-line drugs in sub-Saharan Africa.

The reasons for regimen shift among people living with HIV/AIDS in Asella Referral Hospital

“…However, tuberculosis was the only co-morbid diseases determined in this study, which triggered the regimen modification. This is in line with the study conducted in the UK [16] and Coited'lvoire [17].…”

“…Similarly, in the study conducted in Coited'lvoire [17] and Uganda [18], it was reported that treatment failure was one of the major reasons for discontinuation and modification of initial regimen.…”

First Antiretroviral Therapy Changes in People Living with HIV in Senegal: Incidence, Causes and Predictive Factors

“…These results are consistent with those found in our study. Similarly, the causes of change in treatment observed in our cohort are in accordance with those reported in Côte d'Ivoire [8]: ARV intolerance was the main cause of treatment changes with an incidence rate of 12.4/100 PY and over one third of these changes were due to pregnancy and tuberculosis.…”

“…In Côte d'Ivoire, an overall treatment change incidence of 20.7/100 PY has been reported for a median duration of 16.9 months [8]. In Mali, the incidence rate of ART changes was 16.2/100 PY for a median duration of 15 months [9].…”

Supply Chain Management of Antiretroviral Drugs In Public Health Facilities In Eastern Ethiopia

“…Côte d'Ivoire 16 and Swaziland 17 where AZT based ARV regimens accounted 49.8%, 42.42%, 42.0% and 37.9%, respectively.…”