Reasons for Modification or Discontinuation of First Highly Active Antiretroviral Therapy among Human Immunodeficiency Virus Infected adult Patients at Jimma University Specialized Hospital, South West Ethiopia.

Abstract

Highly active antiretroviral therapy has markedly decreased the morbidity and mortality due to HIV disease. However, toxicities and new TB drug treatment would result in frequent modification or discontinuation of antiretroviral drugs. Objective: To assess reasons for modification or discontinuation of first highly active antiretroviral therapy and risk factors among HIV infected adult patients at Jimma University Specialized Hospital, South West Ethiopia. Methods and materials: Retrospective general cohort study was conducted on 1533 of HIV infected adult naïve patients with > 15 years and on highly active antiretroviral therapy from 2006 to 2010 at ART clinic of Jimma University Specialized Hospital. Kaplan-Meier was used to estimate probability of highly active antiretroviral therapy discontinuation or modification as well as Cox-regression models the associations between modification or discontinuation and toxicities with baseline factors. Coxproportional hazard regression also used to evaluate effect of early modification or discontinuation of highly active antiretroviral therapy on treatment failure. Result: High prevalence (47.7%) of modification and discontinuation was found. Estimated probability of modification or discontinuation within one year of HAART start was 16.6% (15.6– 17.6%). Toxicities were the most frequent 431(71.9%), reason for modification; however, no documented reason for discontinuation. Efavirenz and non-stavudine had lower risk of modification or discontinuation (Hazard ratio (HR) of 95% CI = 0.573(0.465 - 0.707) and 0.397(O.323 – 0.487)) when compared with nevirapine and stavudine based regimens respectively. Positive for tuberculosis screen and bedridden patients had higher hazard of modification or discontinuation (Hazard ratio (HR) = 1.411(1.162-1.714) and 1.485(1.054-2.093)). Early modification or discontinuation had associated [(HR) = 2.29(1.56 - 23.36)] with treatment failure. Age > 35 years and positive for Tuberculosis had high hazard of toxicities ((HR) =1.326(1.091-1.612) and 1.473(1.120-1.938)) where efavirenz and non- stavudine containing regimens had lower hazard ((HR= 0.570(0.425-0.765) and 0.298(0.217- 0.411)) for toxicities. Conclusions: High prevalence of modification and discontinuation of highly active antiretroviral therapy, particularly due to toxicities. Positive for TB screen and the use of stavudine and nevirapine containing regimen had high risk of modification or discontinuation and also for toxicities. Close monitoring and management of toxicities are crucial for durability of highly active antiretroviral therapy.