Differences and risk factors of regimen modification in acquired immunodeficiency syndrome patients who initiated antiretroviral treatment / 中华传染病杂志

Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.

Factors determinant for change of initial antiretroviral treatment regimen among patients on ART follow-up clinic of Mekelle Hospital, Mekelle, Ethiopia.

Background: Treatment interruption and switch to a new Highly Active Antiretroviral Therapy (HAART) regimen act as competing risks for patient on HAART. Methods: The study was conducted in Mekelle hospital. A case-control study was conducted. Socio-demographic, immunologic and clinical characteristics were components of the checklist. Data was compiled, processed, and analyzed using Statistical Package for Social Sciences (SPSS) for windows version 16. Ethical consideration was obtained from Mekelle University. Results: 105 patients’ records were sampled and studied. Twenty one (20%) of the patients had changed their initial ART regimen and about three-fourth 15 (71.4%) of the reasons for change was attributable to toxicity while 3 and 2 were due to treatment failure and pregnancy respectively. The odds of Adverse Drug Reactions (ADRs) who had one initial ART change (cases) were 2.37 times greater than the odds who did not change (controls) Patients, initiated ZDV based ART regimen had 9.93 times greater chance of changing their initial ART regimen compared to those initiated with D4T based ART regimen and patient on ART for treatment duration of 12-36 months were relatively at higher risk compared to patients with lesser duration of treatment. Patients who’s ART had 99.94% lesser chance of changing their baseline ART regimen compared to those who did take other medications Conclusions: The main factor determining the change of initial ART regimen in our study was the occurrence of adverse drug reactions, with ZDV being the most dominant drug.