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.