Multi-state models for the analysis of time-to-treatment modification among HIV patients under highly active antiretroviral therapy in Southwest EthiopiaReportar como inadecuado

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BMC Infectious Diseases

, 17:453

First Online: 27 June 2017Received: 07 October 2016Accepted: 07 June 2017


BackgroundHighly active antiretroviral therapy HAART has shown a dramatic change in controlling the burden of HIV-AIDS. However, the new challenge of HAART is to allow long-term sustainability. Toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. The aim of this study was to evaluate the durability of first line antiretroviral therapy and to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART.

MethodsA Hospital based retrospective study was conducted from January 2007 to August 2013 at Jimma University Hospital, Southwest Ethiopia. Data on the prescribed ARV along with start date, switching date, and reason for change was collected. The primary outcome was defined as the time-to-treatment change. We adopted a multi-state survival modeling approach assuming each treatment regimen as state. We estimate the transition probability of patients to move from one regimen to another.

ResultA total of 1284 ART naive patients were included in the study. Almost half of the patients 41.2% changed their treatment during follow up for various reasons; 442 34.4% changed once and 86 6.69% changed more than once. Toxicity was the most common reason for treatment changes accounting for 48.94% of the changes, followed by comorbidity New TB 14.31%. The HAART combinations that were robust to treatment changes were tenofovir TDF + lamivudine 3TC+ efavirenz EFV, tenofovir + lamivudine 3TC + nevirapine NVP and zidovudine AZT + lamivudine 3TC + nevirapine NVP with 3.6%, 4.5% and 11% treatment changes, respectively.

ConclusionMoving away from drugs with poor safety profiles, such as stavudined4T, could reduce modification rates and this would improve regimen tolerability, while preserving future treatment options.

KeywordsHIV-AIDS Highly active antiretroviral therapy Treatment modification Survial analysis Multistate models AbbreviationsARTAntiretroviral therapy

HAARTHighly active antiretroviral therapy

NRTINucleotide reverse transcriptase inhibitors

NNRTINon nucleotide reverse transcriptase inhibitors

WHOWorld Health Organization

VCTVoluntary counselling and testing

PMTCTPrevention of mother-to-child transmission

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-017-2533-3 contains supplementary material, which is available to authorized users.

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Autor: Belay Birlie - Roel Braekers - Tadesse Awoke - Adetayo Kasim - Ziv Shkedy


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