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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/24459

Title: Multi-state models for the analysis of time-to-treatment modification among HIV patients under highly active antiretroviral therapy in Southwest Ethiopia
Authors: Birlie, Belay
Braekers, Roel
Awoke, Tadesse
Kasim, Adetayo
Shkedy, Ziv
Issue Date: 2017
Publisher: BIOMED CENTRAL LTD
Citation: BMC INFECTIOUS DISEASES, 17, p. 1-13 (Art N° 453)
Abstract: Background: Highly 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. Methods: A 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. Result: A 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. Conclusion: Moving away from drugs with poor safety profiles, such as stavudine(d4T), could reduce modification rates and this would improve regimen tolerability, while preserving future treatment options.
Notes: [Birlie, Belay] Jimma Univ, Dept Stat, Jimma, Ethiopia. [Braekers, Roel; Shkedy, Ziv] Hasselt Univ, I BioStat, Diepenbeek, Belgium. [Awoke, Tadesse] Univ Gondar, Inst Publ Hlth, Gondar, Ethiopia. [Kasim, Adetayo] Univ Durham, Wolfson Res Inst Hlth & Wellbeing, Manchester, Lancs, England.
URI: http://hdl.handle.net/1942/24459
DOI: 10.1186/s12879-017-2533-3
ISI #: 000404338000001
ISSN: 1471-2334
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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