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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Incidence and predictors of first line antiretroviral regimen modification in Western Kenya
PLoS ONE, Volume 9, No. 4, Article e93106, Year 2014
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Description
Background: Limited antiretroviral treatment regimens in resource-limited settings require long-term sustainability of patients on the few available options. We evaluated the incidence and predictors of combined antiretroviral treatment (cART) modifications, in an outpatient cohort of 955 patients who initiated cART between January 2009 and January 2011 in western Kenya. Methods: cART modification was defined as either first time single drug substitution or switch. Incidence rates were determined by Poisson regression and risk factor analysis assessed using multivariate Cox regression modeling. Results: Over a median follow-up period of 10.7 months, 178 (18.7%) patients modified regimens (incidence rate (IR); 18.6 per 100 person years [95% CI: 16.2-21.8]). Toxicity was the most common cited reason (66.3%). In adjusted multivariate Cox piecewise regression model, WHO disease stage III/IV (aHR; 1.82, 95%CI: 1.25-2.66), stavudine (d4T) use (aHR; 2.21 95%CI: 1.49-3.30) and increase in age (aHR; 1.02, 95%CI: 1.0-1.04) were associated with increased risk of treatment modification within the first year post-cART. Zidovudine (AZT) and tenofovir (TDF) use had a reduced risk for modification (aHR; 0.60 95%CI: 0.38-0.96 and aHR; 0.51 95%CI: 0.29-0.91 respectively). Beyond one year of treatment, d4T use (aHR; 2.75, 95% CI: 1.25-6.05), baseline CD4 counts ≤350 cells/mm3 (aHR; 2.45, 95%CI: 1.14-5.26), increase in age (aHR; 1.05 95%CI: 1.02-1.07) and high baseline weight >60kg aHR; 2.69 95% CI: 1.58-4.59) were associated with risk of cART modification. Conclusions: Early treatment initiation at higher CD4 counts and avoiding d4T use may reduce treatment modification and subsequently improve sustainability of patients on the available limited options. © 2014 Inzaule et al.
Authors & Co-Authors
Inzaule, Seth Chekata
Kenya, Nairobi
Kenya Medical Research Institute
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Otieno, Juliana A.
Kenya, Kisumu
Jaramogi Oginga Odinga Teaching and Referral Hospital
Kalyango, Joan Nakayaga
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Nafisa, Lillian G.
Kenya, Nairobi
Kenya Medical Research Institute
Kabugo, Charles
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Nalusiba, Josephine
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Kwaro, Daniel P.O.
Kenya, Nairobi
Kenya Medical Research Institute
United States, Atlanta
Centers for Disease Control and Prevention
Zeh, Clement E.
United States, Atlanta
Centers for Disease Control and Prevention
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Karamagi, Charles Amnon Sunday
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Statistics
Citations: 34
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0093106
e-ISSN:
19326203
Study Design
Cohort Study
Study Locations
Kenya