title: Antiretroviral treatment changes in adults from Côte d'Ivoire: the roles of tuberculosis and pregnancy.
abstract: OBJECTIVE
  To determine the rates and causes of first antiretroviral treatment changes in HIV-infected adults in Côte d'Ivoire.
  
  
  METHODS
  We evaluated adults who initiated antiretroviral treatment in an outpatient clinic in Abidjan. We recorded baseline and follow-up data, including drug prescriptions and reasons for changing to alternative first-line regimens (drug substitution for any reason but failure) or second-line regimens (switch for failure).
  
  
  RESULTS
  Two thousand and twelve HIV-infected adults (73% women) initiated antiretroviral treatment. At baseline, 9% of all patients were on treatment for tuberculosis and 3% of women were pregnant. First-line antiretroviral treatment consisted of two nucleoside reverse transcriptase inhibitors (58% stavudine-lamivudine, 42% zidovudine-lamivudine) and efavirenz (63%), nevirapine (32%) or indinavir (5%). Median follow-up time was 16.9 months. During this time, 205 (10%) patients died and 261 (13%) were lost to follow-up. Overall, the rate of treatment modifications was 20.7/100 patient-years. The most common modifications were drug substitutions for intolerance (12.4/100 patient-years), pregnancy (4.5/100 patient-years) and tuberculosis (2.5/100 patient-years). The rates of intolerance-related substitutions were 17.9/100 patient-years for stavudine, 6.3/100 patient-years for nevirapine, 3.9/100 patient-years for zidovudine and 0.1/100 patient-years for efavirenz. Twenty percent of efavirenz substitutions resulted from pregnancy and 18% of nevirapine substitutions were related to tuberculosis treatment.
  
  
  CONCLUSIONS
  During the first months following antiretroviral treatment initiation, a third of all treatment changes occurred for reasons other than intolerance to the drug or treatment failure. In Africa, drug forecasting is crucial to ensuring the success of HIV treatment programmes. Drugs that do not require interruptions during pregnancy or tuberculosis treatment should be made more readily available as first-line drugs in sub-Saharan Africa.
authors.affiliation: INSERM U897, Université Victor Segalen Bordeaux 2, Bordeaux, France.
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.forename: Julien
authors.initials: J
authors.lastname: Duvignac
authors.forename: Eric
authors.initials: E
authors.lastname: Konan-N'dri
authors.forename: Eric
authors.initials: E
authors.lastname: Komena
authors.forename: Joachim
authors.initials: J
authors.lastname: Gnokoro
authors.forename: Sophie
authors.initials: S
authors.lastname: Karcher
authors.forename: Anthony
authors.initials: A
authors.lastname: Tanoh
authors.forename: Thérèse
authors.initials: T
authors.lastname: N'dri-Yoman
authors.forename: Catherine
authors.initials: C
authors.lastname: Seyler
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D007560:Cote d'Ivoire / Q000453:epidemiology; D057915:Drug Substitution / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D014376:Tuberculosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents