Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria

Abah, Isaac Okoh; Darin, Kristin M.; Ebonyi, Augustine O.; Ugoagwu, Placcid; Ojeh, Victor B; Nasir, Naima; Falang, Kakjing D.; Olaitan, Oluremi; Agbaji, Oche; Idoko, John; Kanki, Phyllis J.

doi:10.1177/2325957414565508

Cited by 13 publications

(24 citation statements)

References 29 publications

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“…Teaching Hospital in Nigeria [23], and a study from India [26]. This might also be because patients in the advanced clinical stage of HIV are more vulnerable to increased drug intake for the treatments of opportunistic infections.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Sever Adverse Drug Reactions Among Patients on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia

Kibret

Ayele

Tesfahun

2019

Preprint

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Background: Due to its nature of chronicity and the trend of using more drugs for patients with HIV, antiretroviral toxicity becomes a major challenge of HIV management. Evidences revealed that magnitude of experiencing at least one form of drug toxicity in different setting have been reached up to 90% among patients on antiretroviral therapy. The main aim of this study was to estimate the incidence and predictors of severe adverse drug reactions among People Living with Human Immunodeficiency Virus (PLHIV) at Debre Markos Referral Hospital. Methods: Retrospective follow up study with survival analysis was carried out among people living with Human Immunodeficiency virus. Mean survival time of the cohort was estimated using Kaplan-Meier method. To model the relationship between explanatory variables and the time to adverse drug reaction, Cox-proportional hazard regression model was fitted. Results: Out of the total 485 participants 67 (13.81%; 95% C.I: 10.7%, 16.8%) had experienced sever adverse drug reactions (ADRs). The incidence rate of severe adverse drug reaction development was 3 per 100-person years. Patients residing out of the catchment area to the facility were 73% at higher risk to develop ADR at any time, compared to those living within the catchment area (AHR=1.73; 95% C.I: 1.04, 2.86). The risk of ADRs among patients with baseline WHO clinical stage of III and IV was 2.59 times higher at any time compared to those with WHO stages I and II (95% C.I: 1.54, 4.36). Conclusion: The incidence of adverse drug reactions was relatively lower than reported in different parts of Ethiopia and other African countries. However, the overall burden in the 10 years period was still high. Health professionals working in the ART clinic need to give special attention for patients coming from outside of catchment areas, commercial sex workers and drivers and patients on advanced WHO clinical stages to prevent ADR development among these groups.

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Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Sever Adverse Drug Reactions Among Patients on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia

Kibret

Ayele

Tesfahun

2019

Preprint

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“…Factors prior to ART initiation that contribute to ART failure are HIV clinical stage IV and lower CD4 count. [12][13][14][15][16][17][18] During the treatment, lack of adherence and period of treatment contribute to treatment failure. [17][18][19][20][21][22][23][24] Several other studies have evaluated association between treatment failure and clinical indicators such as opportunistic infections (OIs), drug regiments, modes of HIV transmission, haemoglobin level, body mass index (BMI), drug toxicity and first line ARV resistence.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19][20][21][22][23][24] Several other studies have evaluated association between treatment failure and clinical indicators such as opportunistic infections (OIs), drug regiments, modes of HIV transmission, haemoglobin level, body mass index (BMI), drug toxicity and first line ARV resistence. 15,16,20,25,26 These studies have also examined relationship between treatment failure and sociodemographic variables such as age, sex, employment, education level and marital status. 12,15,17,21,[26][27][28] Data from Bali Provincial Health Office in 2015 showed that as many as 96.2% of 1,173 HIV/AIDS patients were on first line ART.…”

Section: Introductionmentioning

confidence: 99%

“…15,16,20,25,26 These studies have also examined relationship between treatment failure and sociodemographic variables such as age, sex, employment, education level and marital status. 12,15,17,21,[26][27][28] Data from Bali Provincial Health Office in 2015 showed that as many as 96.2% of 1,173 HIV/AIDS patients were on first line ART. 29 In 2015, there were 54 voluntary counselling and testing (VCT) facilities available across Bali Province, seven hospitals/clinics providing first line ART and only three hospitals providing second line ART.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali

Astiti

Sawitri

Merati

2017

phpma

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Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.

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“…Although there are several possible reasons for modifying ART, previous studies reported development of toxicity and adverse effects as the main reason 17 18. Our results are similar to those studies, with 46.7% of patients (43/92) switching their ART because of toxicity and adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Analysis of antiretroviral therapy modification in routine clinical practice in the management of HIV infection

et al. 2016

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ObjectivesThe main goal was to assess the reasons for antiretroviral therapy (ART) change in patients with HIV in a hospital setting in routine clinical practice. The economic impact of ART modification was also analysed.MethodsPatients with HIV who changed their ART between 24 November and 24 December 2014 were registered. Length of initial therapy, type of ART before and after therapy modification, and reasons for the ART change were analysed. To assess the economic impact, antiretroviral drug costs at the time of the study were recorded.ResultsOf a cohort of 3850 patients with HIV, 1976 attended for pharmaceutical care consultation at Hospital Universitario La Paz during the study period. Ninety-two patients (4.7%) had their ART modified. The median length of the previous therapy was 26 months (range 1–144). The most common initial therapy regimen was 2 nucleoside reverse transcriptase inhibitors (NRTI)+1 non-nucleoside reverse transcriptase inhibitor (NNRTI) (29.4%), and the most common one after modification was 2 NRTI+1 integrase strand transfer inhibitor (INSTI) (40.2%). Forty-three modifications were made because of toxicity and adverse effects (46.7%), 25 because of therapy simplification (27.2%), 16 because of treatment failure (17.4%), and 8 because of drug–drug interactions (8.7%). ART costs increased by a mean of €14 (SD €216; range −€528 to +€831) per month per patient after therapy modification at the time of study.ConclusionsToxicity and adverse effects were the most common reason for ART alteration in patients with HIV in routine clinical practice in a hospital setting. Better knowledge about factors that motivate these changes may contribute to decreased toxicity and increased treatment success. ART modification had a variable but not very substantial economic impact.

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Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria

Abstract: Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.

Cited by 13 publications

References 29 publications

Incidence and Predictors of Sever Adverse Drug Reactions Among Patients on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia

Incidence and Predictors of Sever Adverse Drug Reactions Among Patients on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia

Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali

Analysis of antiretroviral therapy modification in routine clinical practice in the management of HIV infection

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