Modification of First-line Antiretroviral Therapy in Treatment-naive, HIV Positive PatientsCorrespondence Address :
Dr. Chaithanya Malalur,
Medical advisor, Biochem Pharmaceuticals (Zydus Cadila), 1st floor, Ackruti Star, Opposite Ackruti Center Point,
MIDC central road, Andheri East, Mumbai - 400093, Mumbai, Maharashtra, India.
Introduction: Modification of initial Antiretroviral Therapy (ART) program is an important issue in HIV infected patients as the number of ART regimens available is limited. Hence, there is a need to understand the factors that affect modification and therefore, the durability of the initial antiretroviral regimen.
Aim: To study the type of modification of first line ART in treatment-naive HIV positive patients and factors influencing it.
Materials and Methods: A retrospective observational study was carried out in the HIV clinic of a tertiary care hospital, using data obtained from the case records of the subjects who were initiated on ART between January 2012 to December 2014. Data on patient baseline characteristics, proportion of patients who required modification, type and time of modification was collected. The determinants of time to modification were analysed using Chi-square test. Binomial logistic regression was utilized to assess independent risk factors for change in regimen.
Results: Out of 200 case records analysed, 54 patients had to undergo a modification in their initial regimen. The mean age of patients was 44.68 ± 11.31 years. Majority of the patients were males. The most common reason for modification was Adverse Drug Reactions (ADRs) (79.63%) followed by treatment failure (9.25%). In 85.18% cases, modification involved substitution. Occurrence of ADRs and non-tenofovir based first-line regimens were associated with higher likelihood of substitution in regimen (p<0.05). The median time (IQR) to modification was 173 (152.25, 293.50) days.
Conclusion: ADRs and the use of non-tenofovir based regimens resulted in significantly higher rates of modification of antiretroviral therapy. There should be monitoring of patients on ART to detect ADRs at the earliest and to obtain increased use of single tablet containing tenofovir based regimen to improve durability of first line regimens.
Adverse drug reactions, AIDS, Durability, Tenofovir
Smita Shenoy, Dhairya Shrivastava, Chaithanya Malalur, Muralidhar Varma, Sushil Kiran Kunder, Avinash Arivazhahan, et al.. MODIFICATION OF FIRST-LINE ANTIRETROVIRAL THERAPY IN TREATMENT-NAIVE, HIV
POSITIVE PATIENTS. Journal of Clinical and Diagnostic Research [serial online] 2017 October [cited: 2018 Jan 21 ]; 11:FC01-FC05. Available from
Date of Submission: Feb 06, 2017
Date of Peer Review: Mar 18, 2017
Date of Acceptance: Jul 13, 2017
Date of Publishing: Oct 01, 2017
FINANCIAL OR OTHER COMPETING INTERESTS: None.
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