Antiretroviral durability and tolerability in HIV-infected adults living in urban Kenya.
BACKGROUND
Insufficient data exist on the durability and tolerability of first-line antiretroviral therapy (ART) regimens provided by HIV treatment programs implemented in developing countries.


METHODS
Longitudinal observation of clinical, immunologic, and treatment parameters of all HIV-infected adult patients initiated on ART was performed at Saint Mary's Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.


RESULTS
A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration was 350 days (11.6 months). Significant improvements in clinical and immunologic status were noted after 12 months of therapy. ART switches occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12 months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis treatment interactions (28.1%) were the most frequent reasons for ART switch. Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]: 1.28 to 1.98; P<0.01) and a CD4 count<or=100 cells/mm3 (HR=1.20, CI: 1.01 to 1.43; P=0.04) were independent predictors of ART switch. ART-related clinical toxicity occurred in 341 (26.5%) patients. Peripheral neuropathy was reported most frequently (20.7%). A CD4 count<or=100 cells/mm3 was an independent predictor of clinical toxicity.


CONCLUSIONS
Excellent clinical and immunologic responses to ART were observed in this urban Kenyan population; however, frequent switches in ART among medication classes because of toxicity or drug interactions may limit the durability of these responses.
Hawkins
Claudia
C
Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA, and Department of Medicine, Saint Mary's Mission Hospital, Nairobi, Kenya. c-hawkins@md.northwestern.edu
Achenbach
Chad
C
Fryda
William
W
Ngare
Duncan
D
Murphy
Robert
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D004359:Drug Therapy, Combination; D005076:Exanthema / Q000139:chemically induced / Q000517:prevention & control; D005260:Female; D006078:Government Programs / Q000639:trends; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000517:prevention & control; D011336:Probability; D018571:Sentinel Surveillance; D016896:Treatment Outcome; D014505:Urban Population
D044966:Anti-Retroviral Agents