Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria

• Main Authors: Isaac Okoh Abah BPharm, MSc, Kristin M. Darin PharmD, Augustine Odo Ebonyi MBBS, MSc, Placcid Ugoagwu BSc, Victor Bazim Ojeh BPharm, Naima Nasir BPharm, Kakjing D. Falang BPharm MSc, Oluremi Olaitan BPharm, Msc, Oche Agbaji MBBS, John Idoko MBBS, Phyllis Kanki DVM, SD
• Format: Article
• Language: English
• Published: SAGE Publishing 2015-07-01
• Series: Journal of the International Association of Providers of AIDS Care
• Online Access: https://doi.org/10.1177/2325957414565508

Objective: We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria. Method: Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis. Results: Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count ≤100 cells/mm 3 (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43). Conclusion: Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.