Abstract:
Background: Combination antiretroviral therapy (cART) is the cornerstone of managing patients
with HIV infection. Once cART is initiated, patients generally remain on medications indefinitely.
However, antiretroviral regimens commonly require changes which often involve switches of
multiple medications simultaneously. The maximal regimen durability with regard to safety and
efficacy is a critical factor for long-term success of ART since modification to cART has a number
of challenges.
Objectives: To assess the rate, time to change, reasons and predictors of treatment modification
among HIV/AIDS patients at Pawe General Hospital.
Method: Hospital based retrospective cohort study was conducted among adult HIV/AIDS
patients on follow-up in Pawe Hospital from 01 April 2017 to 30 April 2017. Patients who started
cART at Pawe General Hospital from January 2012 to December 2016 were included. Data
abstraction tool was used to collect data from patient chart. Data were analyzed using SPSS version
21. Descriptive statistics were used to summarize patient socio-demographics characteristics and
rate of regimen modification. Bivariate and multivariate Cox proportional hazard were performed
to identify the predictors.
Result: Over a median follow-up period of 21 months (IQR 6 - 38), 62 (14.5%) patients modified
their initial regimens (incidence rate (IR); 7.66 per 100 person years [95% CI: 5.84 – 9.50]).
Toxicity was the most common reason (72.6%). In multivariate Cox regression model, WHO
stage III/IV at initiation (AHR; 2.39, 95% CI: 1.23 – 4.66), AZT based initial NRTI backbone
(AHR; 8.19, 95% CI: 4.55 - 14.73), low baseline hemoglobin ((< 7 g/dl [AHR; 6.32, 95% CI:
1.40 – 28.58] and 7-9.9 g/dl [AHR 4.21, 95% CI: 1.92 - 9.22]) and co-medication with cART
(AHR 1.73, 95% CI: 1.03 - 2.89) were associated with increased risk of treatment modification.
Conclusion: Initial regimen modification rate was lower in this population than cohorts in
resource-rich settings. Toxicity was the most common reason for modification and WHO stage
III/IV, AZT based regimen, low baseline hemoglobin and co-medication with cART were found
to be predictors of regimen modification.
