Abstract
Background : Optimization of initial highly active antiretroviral therapy (HAART) for complete viral suppression and better tolerability is paramount for the prognosis of HIV-infected patients. Durable suppression of HIV therefore depends on the use of potent, well-tolerated antiretroviral regimens to which patients can easily adhere. The aim is to determine the outcome and factors influencing the choice of initial combination antiretroviral drugs in the treatment-naive HIV patients. Methods : The outcome and factors influencing the choice of initial antiretroviral drugs were investigated in HIV-infected treatment-naive individuals in a large HIV treatment clinic in south-western Nigeria using a cross-sectional design between January to December 2010. Results : 432 patients were analyzed (mean age 38 years ± 9.010), 67.6% females, 50.1% prior AIDS. Mean CD4 cells and HIV RNA were 146 cells/mm 3 and 194312 copies/ml respectively. Zidovudine-lamivudine-nevirapine regimen (ZDV-3TC-NVP) was prescribed in 34.3%, followed by tenofovir-emtricitabine-efavirenz (TDF-FTC-EFV) 26.9%, TDF-FTC-NVP (17.6%), TDF-3TC-NVP (8%), ZDV-3TC-EFV (4.6%), abacavir (ABC)-3TC-EFV (3.7%), ABC-3TC-NVP (2.8%). Difference in prescription was noted among the doctors. Compared with TDF-3TC-NVP, starting TDF-FTC-EFV was mainly associated in multivariate analysis with reduced pill burden (P 200,000 copies/ml (P=0.0015). TDF-3TC-NVP and TDF-3TC-ZDV-atazanavir (ATV)-ritonavir (RTV) were more likely in patients with drug substitution and switch programs respectively (P<0.001; P<0.001). ABC-3TC-EFV was more likely in patients with deranged creatinine levels (P=0.002). At 6 months and 12 months, 364 (84.3%) and 392 (90.7%) achieved virologic suppression respectively (HIV RNA copies <200 copies/ml). CD4 cells increased by 138 cells/mm 3 and 198 cells/mm 3 at 6 months and 12 months respectively. Virologic suppression was more likely with TDF-FTC-EFV (93.7%) while CD4 cells increase was higher with ZDV-3TC-NVP. The 2 most common often prescribed regimens, TDF-FTC-EFV and ZDV-3TC-NVP, had virologic response rates of 93.7% and 84.2% (P<0.001). Conclusion : Factors such as physician preference and patient-reported features play a role in the choice of initial HAART regimen. Identification of these features and simplification of treatment regimens will be necessary in order to maximize the effectiveness of HAART regimens.
Published Version
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