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: 5.55). 02/2001; 15(2):185-94. DOI: 10.1097/00002030-200101260-00007
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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Available from: Anne M Johnson, Jan 14, 2015
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    • "Various factors can degrade adherence and these include the doctor-patient relationship, socioeconomic factors, and medication factors. According to many previous studies, adverse drug effects are one of the main factors leading to reduced ad- herence[7,1617181920. The most common adverse effects of antiretroviral drugs are rash, hypersensitivity reaction, anemia, gastrointestinal discomfort , jaundice, and side effects on the central nervous system (CNS). "
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    • "This difference is likely due to close treatment monitoring or potential selection bias of persons enrolled in clinical trials and programs as compared to those in routine clinical settings. The rates are however still lower than those observed in developed nations where cART modifications are as high as >50% [9], [25], [26]. The difference may probably be due to limited cART options or the pre-determined population based ART guidelines in these settings, which is likely to influence the clinicians’ decision on cART modification. "
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    • "The findings of this review are supported by previous studies reporting on the impact of HIV treatment-related AEs. In the Italian Cohort of Antiretroviral-Naïve Patients, 21.1% of participants discontinued combination ART due to treatment toxicity over a median follow-up period of 45 weeks, whereas only 5.1% of participants in the same population discontinued therapy due to treatment failure (Mocroft et al., 2001; Monforte et al., 2000). Moreover, a study conducted by Stone et al. (2001) in the HIV Epidemiology Research cohort, indicated that patients who reported having two or more adverse reactions to ART were more likely to discontinue treatment than patients who did not experience these reactions. "
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