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Prevalence and correlates of first line Antiretroviral therapy change among adult HIV patients attending HIV care and treatment services in north western rural part of Tanzania: a cross sectional study

Daniel W Gunda, Semvua B Kilonzo, Anna G Samwel, Bonaventura C.T Mpondo, Elichilia R Shao



HIV/AIDS is an ongoing health problem causing still high morbidity and mortality. ART have provided significant clinical benefits leading into reduced mortality and morbidity which requires tolerable, affordable and virologically potent regimens for its durability. Frequent need for change of ART regimes is a challenging problem especially in resource limited settings including Tanzania where there are few options to switch into. This study was designed to determine the frequency, reasons and predictors of ART change in rural Tanzania. 

Materials and Methods

A cross sectional study was done involving adult HIV positive patients who were initiated on ART between 2005 and 2014. The patients were enrolled serially through routine HIV care and treatment services in eastern rural part of Lake Zone.  Information of research interest including demographic data, on diagnosis WHO clinical stage, baseline CD4 counts, year and criterion of ART initiation, initial ART regimen, ART change status, reason for ART regimen change,  time on initial ART   and enrollment CD4 counts were collected and analyzed using  stata version 12.                       


A total of 670 patients were enrolled in this study where 220(32.94%) were found to have changed their ART regimen with a first line regimen of 27.5 [IQR=14-38] months.  ART toxicity was the most common reason of ART change which 106 (48.18 %) and the odds of having ART change were strongly predicted by age>40, being divorced(OR=2.4 ,p=0.0012),  baseline CD4 counts <200 cells/µl (OR=3.9, p<0.001), being initiated on ART due to low CD4<200 cells/µl(OR=2.0, p<0.001) or being  initiated on ART with CD4< 350 cells/µl and WHO clinical stage 3(OR=2.2, p<0.001) and d4T based regimen (OR=138, p<0.001)


ART change is a very frequent problem in rural Tanzania, which is strongly predicted by diagnosis of HIV in older patients, Advanced HIV parameters and d4T based regimens. Universal screening programs to diagnose HIV in earlier ages and in less advanced HIV parameters and subsequent early initiation of less toxic ART regimens could significantly contribute to the reduction of this problem in our setting where we have limited potent options to go for.



HIV/AIDS, adult HIV patients, initial ART regimen change, rural Tanzania

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Brooks, J.T., et al., HIV-associated opportunistic infections--going, going, but not gone: the continued need for prevention and treatment guidelines. Clin Infect Dis, 2009. 48(5): p. 609-11.

WHO, 10 Facts on HIV/AIDS, 2015. Geneva, Switzerland.

Le, T., et al., Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy. N Engl J Med, 2013. 368(3): p. 218-30.

Reniers, G., et al., Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA). AIDS, 2014. 28 Suppl 4: p. S533-42.

Wong, K.H., K.C. Chan, and S.S. Lee, Delayed progression to death and to AIDS in a Hong Kong cohort of patients with advanced HIV type 1 disease during the era of highly active antiretroviral therapy. Clin Infect Dis, 2004. 39(6): p. 853-60.

Quinn, T.C., et al., Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med, 2000. 342(13): p. 921-9.

Ives, N.J., B.G. Gazzard, and P.J. Easterbrook, The changing pattern of AIDS-defining illnesses with the introduction of highly active antiretroviral therapy (HAART)in a London clinic. J Infect, 2001. 42(2): p. 134-9.

Berrey, M.M., et al., Treatment of primary human immunodeficiency virus type 1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS. J Infect Dis, 2001. 183(10): p. 1466-75.

King, J.T., Jr., et al., Long-term HIV/AIDS survival estimation in the highly active antiretroviral therapy era. Med Decis Making, 2003. 23(1): p. 9-20.

Ledergerber, B., et al., AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA, 1999. 282(23): p. 2220-6.

Tozser, J., HIV inhibitors: problems and reality. Ann N Y Acad Sci, 2001. 946: p. 145-59.

WHO, Global Health Observatory (GHO) data. WHO/HIV-AIDS, 2015.

MOHSW, National Guideline for the Management of HIV an AIDS. 2015.

Inzaule, S., et al., Incidence and predictors of first line antiretroviral regimen modification in western Kenya. PLoS One, 2014. 9(4): p. e93106.

Hawkins, C., et al., Antiretroviral durability and tolerability in HIV-infected adults living in urban Kenya. J Acquir Immune Defic Syndr, 2007. 45(3): p. 304-10.

WHO, Table 7.15 WHO definitions of clinical, immunological and virological failure for the decision to switch ART regimens. 2010.

Nuesch, R., et al., Monitoring the toxicity of antiretroviral therapy in resource limited settings: a prospective clinical trial cohort in Thailand. J Antimicrob Chemother, 2006. 58(3): p. 637-44.

Sun, J., Reasons and Risk Factors for the Initial Regimen Modification in Chinese Treatment-Naïve Patients with HIV Infection: A Retrospective Cohort Analysis. LoS One. , 2015. 10(7).

van Roon, E.N., et al., Incidence of discontinuation of highly active antiretroviral combination therapy (HAART) and its determinants. J Acquir Immune Defic Syndr Hum Retrovirol, 1999. 20(3): p. 290-4.

d'Arminio Monforte, A., et al., Insights into the reasons for discontinuation of the first highly active antiretroviral therapy (HAART) regimen in a cohort of antiretroviral naive patients. I.CO.N.A. Study Group. Italian Cohort of Antiretroviral-Naive Patients. AIDS, 2000. 14(5): p. 499-507.

Tsuchiya, N., et al., Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study. BMC Infect Dis, 2014. 14: p. 565.

Braitstein, P., et al., Sustainability of first-line antiretroviral regimens: findings from a large HIV treatment program in western Kenya. J Acquir Immune Defic Syndr, 2010. 53(2): p. 254-9.

Trotta, M.P., et al., Treatment-related factors and highly active antiretroviral therapy adherence. J Acquir Immune Defic Syndr, 2002. 31 Suppl 3: p. S128-31.

Tuldra, A. and A.W. Wu, Interventions to improve adherence to antiretroviral therapy. J Acquir Immune Defic Syndr, 2002. 31 Suppl 3: p. S154-7.

Sivadasan, A., et al., High rates of regimen change due to drug toxicity among a cohort of South Indian adults with HIV infection initiated on generic, first-line antiretroviral treatment. J Assoc Physicians India, 2009. 57: p. 384-8.

Anlay, D.Z., Z.A. Alemayehu, and B.A. Dachew, Rate of initial highly active anti-retroviral therapy regimen change and its predictors among adult HIV patients at University of Gondar Referral Hospital, Northwest Ethiopia: a retrospective follow up study. AIDS Res Ther, 2016. 13: p. 10.

Eluwa, G.I., et al., Adverse drug reactions to antiretroviral therapy (ARVs): incidence, type and risk factors in Nigeria. BMC Clin Pharmacol, 2012. 12: p. 7.

Abah, I.O., et al., Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria. J Int Assoc Provid AIDS Care, 2015. 14(4): p. 348-54.

Vo, T.T., et al., Durability and outcome of initial antiretroviral treatments received during 2000--2005 by patients in the Swiss HIV Cohort Study. J Infect Dis, 2008. 197(12): p. 1685-94.

Elzi, L., et al., Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008. Arch Intern Med, 2010. 170(1): p. 57-65.

Le Moing, V., et al., Long-term evolution of CD4 count in patients with a plasma HIV RNA persistently <500 copies/mL during treatment with antiretroviral drugs. HIV Med, 2007. 8(3): p. 156-63.

Kaufmann, G.R., et al., Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy. Clin Infect Dis, 2005. 41(3): p. 361-72.

Kaufmann, G.R., et al., The extent of HIV-1-related immunodeficiency and age predict the long-term CD4 T lymphocyte response to potent antiretroviral therapy. AIDS, 2002. 16(3): p. 359-67.

Hunt, P.W., et al., Continued CD4 cell count increases in HIV-infected adults experiencing 4 years of viral suppression on antiretroviral therapy. AIDS, 2003. 17(13): p. 1907-15.

Viengchareun, S., et al., Mitochondrial toxicity of indinavir, stavudine and zidovudine involves multiple cellular targets in white and brown adipocytes. Antivir Ther, 2007. 12(6): p. 919-29.

Ait-Mohand, H., et al., Viral efficacy maintained and safety parameters improved with a reduced dose of stavudine: a pilot study. HIV Med, 2008. 9(9): p. 738-46.

Murphy, R.A., et al., Antiretroviral therapy-associated toxicities in the resource-poor world: the challenge of a limited formulary. J Infect Dis, 2007. 196 Suppl 3: p. S449-56.

Domingos, H., et al., Metabolic effects associated to the highly active antiretroviral therapy (HAART) in AIDS patients. Braz J Infect Dis, 2009. 13(2): p. 130-6.

Kumarasamy, N. and S. Krishnan, Beyond first-line HIV treatment regimens: the current state of antiretroviral regimens, viral load monitoring, and resistance testing in resource-limited settings. Curr Opin HIV AIDS, 2013. 8(6): p. 586-90.

WHO, Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. World Health Organization Press; 2013., 2013.

Gallant, J.E., et al., Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA, 2004. 292(2): p. 191-201.

Rawizza, H.E., et al., Immunologic criteria are poor predictors of virologic outcome: implications for HIV treatment monitoring in resource-limited settings. Clin Infect Dis, 2011. 53(12): p. 1283-90.

Vallabhaneni, S., et al., Evaluation of WHO immunologic criteria for treatment failure: implications for detection of virologic failure, evolution of drug resistance and choice of second-line therapy in India. J Int AIDS Soc, 2013. 16: p. 18449.




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