Anti-Retroviral Regimen Change & Subsequent Patient–Related Outcomes in South Africa

The aim of the study was to identify factors that influence antiretroviral therapy (ART) regimen change and to evaluate patient outcomes post regimen change. A retrospective chart analysis of 269 HIV-infected non-pregnant patients (age >18 years), who underwent an antiretroviral (ARV) regimen change and were followed up for approximately one year since initiation, was undertaken at a Provincial Hospital ARV Clinic in KwaZulu-Natal, from January 2008 to December 2012. The findings revealed that 200 of the 269 cases were female (75 percent). The majority of the patients were between the ages of 30 and 44. (57.6 percent). Only five of the individuals had tuberculosis (TB) infection (2 percent). The most common first-line ART regimen to be changed was stavudine (D4T)/ lamivudine(3TC)/ efavirenz(EFV) n = 111(41%). The most common regimen patients were changed to was tenofovir (TDF)/3TC/EFV n = 89(33%). Stavudine was the most commonly substituted drug (35.5%). Lipodystrophy was the most common ADR (56.8%). ADR was the indication for ART regimen change in 175 patients (65%), whilst Treatment failure (TF) accounted for ART regimen change in 94 patients (35%). Immunological success (CD4 counts) was shown after regimen change (374.21 ± 243.16 vs. 456.09 ± 250.07, CI: 0.95, p < 0.001). Following the regimen adjustment, undetectable virus levels were found in 172/205 (83.9%) individuals. This study concluded that adverse drug reactions (ADRs) were the main cause for antiretroviral regimen change. Stavudine was the most substituted drug with lipodystrophy being the most common side effect. Immunological and virological success was shown after regimen modification.