Article

Reasons for modification and discontinuation of antiretrovirals: results from a single treatment centre.

Department of Primary Care and Populations Sciences, Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, London, UK.
AIDS (impact factor: 6.24). 02/2001; 15(2):185-94. pp.185-94
Source: PubMed

ABSTRACT To describe the reasons for, and factors associated with, modification and discontinuation of highly active antiretroviral therapy (HAART) regimens at a single clinic.
A total of 556 patients who started HAART at the Royal Free Hospital were included in analyses. Modification was defined as stopping or switching any antiretrovirals in the regimen, whereas discontinuation was defined as the simultaneous stopping of all antiretrovirals included in the initial regimen. Reasons were classified as immunological/virological failure (IVF) and toxicities and patient choice/poor compliance (TPC).
The median CD4 count at starting HAART was 171 x 10(6) cells/l and viral load 5.07 log copies/ml. During a median follow-up of 14.2 months, 247 patients (44.4%) modified their HAART regimen, 72 due to IVF (29.1%) and 159 due to TPC (64.4%) and a total of 148 patients (26.6%) discontinued HAART. Older patients were less likely to modify HAART [relative hazard (RH), 0.73 per 10 years; P = 0.0008], as were previously treatment-naive patients (RH, 0.65; P = 0.0050), those in a clinical trial (RH, 0.64; P = 0.027) and those who started nelfinavir (RH, 0.57; P = 0.035). Patients who started with four or more drugs (RH, 2.21, P < 0.0001), who included ritonavir in the initial regimen (RH, 1.41; P = 0.035) or who had higher viral loads during follow-up (RH per log increase, 1.51; P < 0.0001) were more likely to modify HAART.
There was a high rate of modification and discontinuation of HAART regimens in the first 12 months, particularly due to toxicities, patient choice or poor compliance.

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Keywords

active antiretroviral therapy
 
clinical trial
 
first 12 months
 
HAART [relative hazard
 
HAART regimen
 
HAART regimens
 
immunological/virological failure
 
initial regimen
 
log increase
 
median CD4 count
 
median follow-up
 
Older patients
 
patient choice
 
patient choice/poor compliance
 
reasons
 
Royal Free Hospital
 
single clinic
 
TPC
 
treatment-naive patients
 
viral load 5.07 log copies/ml
 

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