Durability of First Line Antiretroviral Therapy : Reasons and Predictive Factors for Treatment Modifications in a Swaziland Cohort Simbarashe Takuva 1, 2 , Goedele Louwagie 1 , Khangelani Zuma 1, 3 , Velephi Okello 2 1 School of Health Systems & Public Health, Faculty of Health Sciences , University of Pretoria 2 Ministry of Health and Social Welfare, Mbabane, Swaziland 3 Human Sciences Research Council , Pretoria, South Africa
25
Embed
Simbarashe Takuva, AIDS 2010. Durability of first line antiretroviral therapy in Swaziland
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Durability of First Line Antiretroviral Therapy : Reasons and
Predictive Factors for Treatment Modifications in a Swaziland
1 School of Health Systems & Public Health, Faculty of Health Sciences , University of Pretoria2 Ministry of Health and Social Welfare, Mbabane, Swaziland3 Human Sciences Research Council , Pretoria, South Africa
BACKGROUND
High burden of HIV / AIDS in sub-Saharan Africa
Swaziland has highest prevalence in the world
ART has reduced morbidity and mortality
W.H.O 3 x 5 initiative resulted in rapid scale up
At least 35 000 on treatment by beginning of 2009
No data available for drug tolerability and durability
BACKGROUND : Rationale
Optimizing initial ART regimens in terms of durability and
efficacy is paramount for the prognosis of patients initiating
treatment
Where drug options are limited, it is important to understand
the reasons and risk factors that may lead to poor tolerability
of ART
This will help to individualize drug regimens among patients
Most studies done in resourceful settings. Generalizability
difficult
BACKGROUND : SOPs
Initiation of ART based on CD4 counts and WHO staging
FBC, AST/ALT and CD4 count done at baseline
First line options:
NVP-3TC-d4T
NVP-3TC-AZT
Visits – 2weeks,1, 2, 3 months and then 6 monthly
Patients screened by nurses at all visits
BACKGROUND : Aim of the study
To identify reasons for first line antiretroviral
modifications
• To examine risk factors for first line antiretroviral
modifications
METHODS : Study setting
The Mbabane Government Hospital ART Unit is the largest HIV
outpatient clinic in Swaziland.
Currently 15 800 patients, of which 7 000 are presently on ART [2009]
Standard WHO adapted treatment and care guidelines are followed
Clinic records are kept both in a paper-based form and in an electronic
database
A home-based follow-up system is currently undergoing finalization
METHODS : Study design and population
• We conducted a retrospective cohort study
• We included patients who met the following criteria :
1. HIV-infected adults older than 18 years
2. Initiated 1st line ART between 1 March 2006 and 31 May 2008
3. ART naive
4. The end-date for the follow-up was 31 December 2008
overall, a high proportion of patients are able to tolerate their initial
antiretroviral regimen
lack of alternative treatment options in a RLS
current guidelines are rigid 1
less informed patients
1. World Health Organization , 2006.
DISCUSSION
Toxicity related reasons resulted in most modifications
gastrointestinal toxicities – the most commonly reported toxicities
resulting in treatment modification, especially in resource-rich
cohorts 1-4
burden of peripheral neuropathy and lipodystrophy related to
d4T use was of major concern. Similar findings in Cape Town 5
1. Youle M, et al. AIDS 1998. 2. Hansel A,et al. J Acquir Immune Defic Syndr. 2001. 3.Mocroft A, et al. AIDS 2001. 4. Jeanne P, et al. AIDS 2002. 5. Coetzee D, et al. AIDS 2004.
DISCUSSION
modification due to anaemia related to AZT toxicity were
significant (7.3 % of the modifications). DART trial similar 1
NVP in a treatment regimen was well tolerated, accounting for
less than 10% of the reasons for modification.
The latter is in contrast to resource-rich settings (NVP) 2,3