Reasons for first-line highly active antiretroviral therapy modification : a retrospective survey at the Infectious Disease Care Clinic Princess Marina Hospital, Gaborone, Botswana
Thesis (MFamMed)--Stellenbosch University, 2018.
ENGLISH SUMMARY : Background: Limited highly active antiretroviral therapy (HAART) in resource-constrained countries makes the optimisation of first-line HAART regimens critical in order to improve treatment efficacy and overall prognosis. Relevant data from resource-constrained settings is still limited. HAART has been available in Botswana since 2002, providing a unique opportunity to evaluate the rate of, the reasons for and the factors associated with first-line HAART modification. Method: This retrospective survey was undertaken at the Princess Marina Hospital Infectious Disease Care Clinic, Botswana. The researcher examined the medical records of all patients who had been initiated on first-line HAART between 1 January 2012 and 1 January 2014. This was done to determine the rate of, the reasons for and the factors associated with first-line HAART modification. Results: Of the 199 patients who met the inclusion criteria and had been initiated on first-line HAART, 48 patients (24% –36 female and 12 male) had undergone regimen modification over a median follow-up period of 6.9 months ( interquartile range 2.1-19.7 months). Drug toxicity accounted for 52% of modifications, 16.8% of patients defaulted, 16.8% had virological failure and 14.6% had their HAART modified due to other reasons. Patients with abnormal liver function tests at initiation of HAART were more likely to have their HAART modified (p = 0.010). Pregnant women on triple antiretroviral prophylaxis were also more likely to have their HAART modified (p = 0.054). Conclusion: There was a lower rate of HAART modification compared to previous studies, mainly attributable to drug side effects or drug toxicity. Evaluating patients with abnormal liver function tests prior to HAART initiation may reduce the modification rate. This would then improve drug tolerability while preserving future drug options.
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