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Abstract

ASSESSMENT OF SWITCHING RATE OF ANTIRETROVIRAL THERAPY FROM FIRST-LINE TO SECOND LINE AMONG HIV INFECTED ADULTS IN NIGERIAN TERTIARY HOSPITAL, CAUSES AND DETERMINANT FACTORS

Mgbahurike A. A.* and Jonah G. I.

ABSTRACT

Introduction: Over the past decade there has been a concerted effort to provide access to antiretroviral therapy for HIV infected individuals in sub Saharan Africa. With increasing exposure to antiretroviral therapy (ART), the risk of resistance and subsequent treatment failure has become more important, and switching of patients to alternative second line regimens is increasingly needed. Switch from first to second line ART is recommended by WHO for patients with virologic failure. The reasons for such treatment failure may be associated mostly with resistance, side effects, toxicity / adverse effects, and pregnancy. Objective: This study was carried out to determine the rate of switching HIV infected patients on ART, from first line to second line regimen, time of switching, and determinants for the switch, in University of Port Harcourt Teaching Hospital. Method: Retrospective cohort study involving HIV infected patients in the University of Port Harcourt Teaching Hospital who are on first line antiretroviral treatment between 2006 and 2016 was carried out to determine the rate of switch of patients from first line to second line therapy. Sample size based on prevalence rate was determined. Ethical approval was obtained and data collection form was used to record relevant data from patients’ folders. Information collected included demographic data of patients, date of initiation of therapy, initial ART combination, CD4 cell level, and viral load (where available), at initiation, date of switch to second line, CD4 cell level and viral load at switch, second line combination switched to, and reason/s for the switch. Collected data were analyzed using statistical package for social sciences (SPSS) version 20. Results: Out of 239 patients assessed, 24(10.04%) switched from first line to second line ART at a rate of 22.9 per 100 person/years (95% CI = 13.3 – 32.5%). Of the patients that switched, 5(20.8%) were male and 19(79.2%) female. Most, 148 (62%), of the patients studied were within the ages of 30 -49 years, while 11(45.8%) that switched were within 40 – 49 years. The mean age of patients that switched was 41.8±10.6 years. The mean CD4 cell count of these patient at initiation of therapy was 212.3±118.91cells/mm3 while at switch the mean CD4 cell count was 221.3 ±175.1 cells/mm3. Of the patients that switched 15(62.5%) spent 2 – 4years, while 1(4.2%) spent 8 – 10years on their first line regimen prior to the switch. Reasons recorded for the switch included side effects 20.8%, toxicity/adverse effects (16.7%), pregnancy 8.3%, treatment failure 16.7% and 37.5% of the switched patients had no recorded reason given for the switch. Conclusion: This study identified a switch rate of 22.9 per 100 person years over a period of 10 years. The switching of patients was hardly based on virologic failure and in most of the switches no reason was documented for the action.

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