The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

Nevin, Christa R.; Ye, Jiatao; Aban, Inmaculada; Mugavero, Michael J.; Jackson, David M.; Lin, Hui‐Yi; Allison, Jeroan J.; Raper, James L.; Saag, Michael S.; Willig, James H.

doi:10.1089/aid.2010.0291

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…The reasons and risk factors for HAART regimen changes have been assessed by studies from resource-rich and resource-limited settings [ 13 – 17 ]. Similarly, in Ethiopia, some studies determined factors contributed to ART regimen change [ 12 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia

et al. 2018

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ObjectiveThis retrospective cohort study is aimed to assess reasons and predictors of regimen change from initial highly active antiretroviral therapy among 1533 Human Immunodeficiency virus-infected adult patients at the Jimma University Tertiary Hospital.ResultsOne in two (47.7%) adults changed their antiretroviral therapy regimen. Patients who were above the primary level of education [Hazard ratio (HR) 1.241 (95% CI 1.070–1.440)] and with human immunodeficiency virus/tuberculosis co-infection [HR 1.405 (95% CI 1.156–1.708)] had the higher risk of regimen change than their comparator. Individuals on Efavirenz [HR 0.675 (95% CI 0.553–0.825)] and non-stavudine [HR 0.494 (95% CI 0.406–0.601)] based regimens had lower risk of regimen change.

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Section: Introductionmentioning

confidence: 99%

Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia

et al. 2018

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“…20 Even if few patients had their initial regimen changed due to stock-outs and adherence issue, it might contribute its own share for the overall drug resistance and present a challenge to limited treatment options that we currently have for these patients. 18,31 To this end, it is important is to maintain uninterrupted supplies of ART drugs in resource limited settings. 32 Patient awareness about HIV/AIDS treatment should also be improved to solve adherence problems.…”

Section: Discussionmentioning

confidence: 99%

Pattern of and reasons for antiretroviral therapy regimen change among adult HIV/AIDS patients at regional hospital in Eastern Ethiopia: A 10-year retrospective study

et al. 2019

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Objectives:Despite the successes of treatment with antiretroviral therapy in reducing morbidity and mortality among HIV-infected patients, long-term sustainability of the initial regimen has become challenging. Therefore, this study is aimed to address pattern of and reasons for change of antiretroviral therapy regimens among HIV/AIDS patients at Jugel Hospital, Eastern Ethiopia.Methods:A retrospective cross-sectional study was conducted to review medical records of 220 patients who had been on treatment and experienced regimen change at least once from September 2006 to August 2016. Structured data abstraction format was customized from World Health Organization guideline. Data were entered in Epi-data version 3.1, and exported to and analyzed with Statistical Package for Social Sciences version 20. Following descriptive statistics, binary logistic regression was run to determine the association between selected variables and second-time regimen change.Results:The mean age of patients was 37.6 (±8.9) years and 62.3% of them were female. Majority of the patients were presented to the hospital with World Health Organization clinical stage III (59.1%) and CD4 count below 200 cells/mm3 (68.6%). The mean duration of stay on initial regimen was found to be 3.26 (±1.92) years. The average number of initial regimen changes per year was 22 (±11.28). In two-thirds (66.36%) of the patients, their initial regimen was changed to tenofovir disproxil fumarate–based alternatives. The most-frequent reason for initial regimen change was toxicity (32.3%). Among those who experienced the regimen change for the first time, the prevalence of second-time regimen change was found to be 18.18%. Patients who had been taking tuberculosis treatment along with antiretroviral therapy were more likely to get their regimen changed for the second-time compared to those who were not infected with tuberculosis (adjusted odds ratio: 3.40; 95% confidence interval: 1.87–6.47). Besides, patients who were on zidovudine-based (adjusted odds ratio: 0.26; 95% confidence interval: 0.33–0.47) and tenofovir disoproxil fumarate–based regimens (adjusted odds ratio: 0.03; 95% confidence interval: 0.01–0.12) were less likely to get their regimen changed for the second-time compared to those who were on stavudine-based regimens.Conclusion:The majority of the patients had their treatment regimen changed because of drug-related toxicities, treatment failure, and comorbid conditions. Some regimen changes might be attributable to failure of either hospital supply system or patient-related factors which would have been prevented considering limited number of treatment options. There must be consideration of risks and benefits prior to changing a particular regimen.

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“…The overall burden of ART regimen changing was relatively lower than rates that have been reported in other studies. This might be due to the introduction of combined fixed-dose combination drugs that are less toxic and more potent [2, 8, 14, 19]. A study conducted by Cotte et al, reported ART modifications to be higher in patients on daily multiple drug regimens than those on FDC [23].…”

Section: Discussionmentioning

confidence: 99%

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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The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

Cited by 5 publications

References 40 publications

Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia

Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia

Pattern of and reasons for antiretroviral therapy regimen change among adult HIV/AIDS patients at regional hospital in Eastern Ethiopia: A 10-year retrospective study

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

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