title: National review of first treatment change after starting highly active antiretroviral therapy in antiretroviral-naïve patients.
abstract: OBJECTIVE
  The aim of the study was to explore the factors surrounding modification of the first antiretroviral (ARV) regimen where drug switch occurred 3 months or more after initiation. Reference was made to the British HIV Association (BHIVA) guidelines on HIV management.
  
  
  METHODS
  A case note and questionnaire-based audit was carried out.
  
  
  RESULTS
  Toxicity was the single most important reason for ARV change and was the only, or a contributory, cause in over half the patients. Virological failure, adherence issues, requirement for treatment simplification, and patient request were other significant reasons cited. In one-third of those with virological failure, six or more months had elapsed between first detection and the time of switching to a new ARV regimen.
  
  
  CONCLUSIONS
  This audit demonstrated broad adherence to the BHIVA guidelines, although the long time before switching ARVs in the setting of virological failure was of some concern, particularly given the continuing and significant occurrence of primary ARV resistance in the UK.
authors.affiliation: North Manchester General Hospital, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hart
authors.forename: H
authors.initials: H
authors.lastname: Curtis
authors.forename: E
authors.initials: E
authors.lastname: Wilkins
authors.forename: M
authors.initials: M
authors.lastname: Johnson
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D006678:HIV / Q000254:growth & development*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D017410:Practice Guidelines as Topic; D006113:United Kingdom; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents