Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir

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dc.contributor.authorNjuguna, Christineen_ZA
dc.contributor.authorOrrell, Catherineen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorLawn, Stephen Den_ZA
dc.date.accessioned2015-11-23T12:31:00Z
dc.date.available2015-11-23T12:31:00Z
dc.date.issued2013en_ZA
dc.description.abstractIntroduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. RESULTS: Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION: Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs.en_ZA
dc.identifier.apacitationNjuguna, C., Orrell, C., Kaplan, R., Bekker, L., Wood, R., & Lawn, S. D. (2013). Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir. <i>PLoS One</i>, http://hdl.handle.net/11427/15302en_ZA
dc.identifier.chicagocitationNjuguna, Christine, Catherine Orrell, Richard Kaplan, Linda-Gail Bekker, Robin Wood, and Stephen D Lawn "Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15302en_ZA
dc.identifier.citationNjuguna, C., Orrell, C., Kaplan, R., Bekker, L. G., Wood, R., & Lawn, S. D. (2012). Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir. PloS one, 8(5), e63596. doi:10.1371/journal.pone.0063596en_ZA
dc.identifier.ris TY - Journal Article AU - Njuguna, Christine AU - Orrell, Catherine AU - Kaplan, Richard AU - Bekker, Linda-Gail AU - Wood, Robin AU - Lawn, Stephen D AB - Introduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. RESULTS: Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION: Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0063596 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir TI - Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir UR - http://hdl.handle.net/11427/15302 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15302
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0063596
dc.identifier.vancouvercitationNjuguna C, Orrell C, Kaplan R, Bekker L, Wood R, Lawn SD. Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir. PLoS One. 2013; http://hdl.handle.net/11427/15302.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Njuguna et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherAdultsen_ZA
dc.subject.otherLipodystrophyen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherToxicityen_ZA
dc.subject.otherDrug research and developmenten_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherTuberculosisen_ZA
dc.titleRates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofoviren_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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