Substitutions due to antiretroviral toxicity or contraindication in the first 3 years of antiretroviral therapy in a large South African cohort.

Hdl Handle:
http://hdl.handle.net/10144/22574
Title:
Substitutions due to antiretroviral toxicity or contraindication in the first 3 years of antiretroviral therapy in a large South African cohort.
Authors:
Boulle, A; Orrell, C; Kaplan, R; Van Cutsem, G; McNally, M; Hilderbrand, K; Myer, L; Egger, M; Coetzee, D; Maartens, G; Wood, R
Journal:
Antiviral Therapy
Abstract:
INTRODUCTION: The patterns and reasons for antiretroviral therapy (ART) drug substitutions are poorly described in resource-limited settings. METHODS: Time to and reason for drug substitution were recorded in treatment-naive adults receiving ART in two primary care treatment programmes in Cape Town. The cumulative proportion of patients having therapy changed because of toxicity was described for each drug, and associations with these changes were explored in multivariate models. RESULTS: Analysis included 2,679 individuals followed for a median of 11 months. Median CD4+ T-cell count at baseline was 85 cells/microl. Mean weight was 59 kg, mean age was 32 years and 71% were women. All started non-nucleoside reverse transcriptase inhibitor-based ART (60% on efavrienz) and 75% started on stavudine (d4T). After 3 years, 75% remained in care on-site, of whom 72% remained on their initial regimen. Substitutions due to toxicity of nevirapine (8% by 3 years), efavirenz (2%) and zidovudine (8%) occurred early. Substitutions on d4T occurred in 21% of patients by 3 years, due to symptomatic hyperlactataemia (5%), lipodystrophy (9%) or peripheral neuropathy (6%), and continued to accumulate over time. Those at greatest risk of hyperlactataemia or lipodystrophy were women on ART > or =6 months, weighing > or =75 kg at baseline. DISCUSSION: A high proportion of adult patients are able to tolerate their initial ART regimen for up to 3 years. In most instances treatment-limiting toxicities occur early, but continue to accumulate over time in patients on d4T. Whilst awaiting other treatment options, the risks of known toxicities could be minimized through early identification of patients at the highest risk.
Affiliation:
Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.za
Publisher:
International Medical Press
Issue Date:
2007
URI:
http://hdl.handle.net/10144/22574
PubMed ID:
17713158
Additional Links:
http://www.intmedpress.com
Language:
en
ISSN:
1359-6535
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorBoulle, A-
dc.contributor.authorOrrell, C-
dc.contributor.authorKaplan, R-
dc.contributor.authorVan Cutsem, G-
dc.contributor.authorMcNally, M-
dc.contributor.authorHilderbrand, K-
dc.contributor.authorMyer, L-
dc.contributor.authorEgger, M-
dc.contributor.authorCoetzee, D-
dc.contributor.authorMaartens, G-
dc.contributor.authorWood, R-
dc.date.accessioned2008-04-08T13:40:13Z-
dc.date.available2008-04-08T13:40:13Z-
dc.date.issued2007-
dc.identifier.citationSubstitutions due to antiretroviral toxicity or contraindication in the first 3 years of antiretroviral therapy in a large South African cohort. 2007, 12 (5):753-60 Antivir. Ther. (Lond.)en
dc.identifier.issn1359-6535-
dc.identifier.pmid17713158-
dc.identifier.urihttp://hdl.handle.net/10144/22574-
dc.description.abstractINTRODUCTION: The patterns and reasons for antiretroviral therapy (ART) drug substitutions are poorly described in resource-limited settings. METHODS: Time to and reason for drug substitution were recorded in treatment-naive adults receiving ART in two primary care treatment programmes in Cape Town. The cumulative proportion of patients having therapy changed because of toxicity was described for each drug, and associations with these changes were explored in multivariate models. RESULTS: Analysis included 2,679 individuals followed for a median of 11 months. Median CD4+ T-cell count at baseline was 85 cells/microl. Mean weight was 59 kg, mean age was 32 years and 71% were women. All started non-nucleoside reverse transcriptase inhibitor-based ART (60% on efavrienz) and 75% started on stavudine (d4T). After 3 years, 75% remained in care on-site, of whom 72% remained on their initial regimen. Substitutions due to toxicity of nevirapine (8% by 3 years), efavirenz (2%) and zidovudine (8%) occurred early. Substitutions on d4T occurred in 21% of patients by 3 years, due to symptomatic hyperlactataemia (5%), lipodystrophy (9%) or peripheral neuropathy (6%), and continued to accumulate over time. Those at greatest risk of hyperlactataemia or lipodystrophy were women on ART > or =6 months, weighing > or =75 kg at baseline. DISCUSSION: A high proportion of adult patients are able to tolerate their initial ART regimen for up to 3 years. In most instances treatment-limiting toxicities occur early, but continue to accumulate over time in patients on d4T. Whilst awaiting other treatment options, the risks of known toxicities could be minimized through early identification of patients at the highest risk.en
dc.language.isoenen
dc.publisherInternational Medical Pressen
dc.relation.urlhttp://www.intmedpress.com-
dc.rightsArchived with kind thanks to International Medical Pressen
dc.subject.meshAcidosis, Lacticen
dc.subject.meshAdulten
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshBody Weighten
dc.subject.meshCohort Studiesen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV-Associated Lipodystrophy Syndromeen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshPeripheral Nervous System Diseasesen
dc.subject.meshPhysician's Practice Patternsen
dc.subject.meshReverse Transcriptase Inhibitorsen
dc.subject.meshRisk Assessmenten
dc.subject.meshRisk Factorsen
dc.subject.meshSex Factorsen
dc.subject.meshSouth Africaen
dc.subject.meshTime Factorsen
dc.subject.meshTreatment Outcomeen
dc.titleSubstitutions due to antiretroviral toxicity or contraindication in the first 3 years of antiretroviral therapy in a large South African cohort.en
dc.contributor.departmentInfectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.zaen
dc.identifier.journalAntiviral Therapyen

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