Rate of initial anti-retroviral treatment modification and its predictors among adult hiv/aids patients at pawe general hospital, benishangul gumuz region, northwest Ethiopia

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.