title: Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria.
abstract: OBJECTIVE
  We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria.
  
  
  METHODS
  Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis.
  
  
  RESULTS
  Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count≤100 cells/mm3 (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43).
  
  
  CONCLUSIONS
  Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria isaacabah@gmail.com.
authors.forename: Isaac Okoh
authors.initials: IO
authors.lastname: Abah
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Darin
authors.affiliation: University of Jos/Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Augustine Odo
authors.initials: AO
authors.lastname: Ebonyi
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Placcid
authors.initials: P
authors.lastname: Ugoagwu
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Victor Bazim
authors.initials: VB
authors.lastname: Ojeh
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Naima
authors.initials: N
authors.lastname: Nasir
authors.affiliation: University of Jos, Jos, Nigeria.
authors.forename: Kakjing D
authors.initials: KD
authors.lastname: Falang
authors.affiliation: AIDS Prevention Initiative in Nigeria, Ltd./Gte, Lagos, Nigeria.
authors.forename: Oluremi
authors.initials: O
authors.lastname: Olaitan
authors.affiliation: University of Jos/Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Oche
authors.initials: O
authors.lastname: Agbaji
authors.affiliation: National Agency for the Control of AIDS (NACA), Abuja, Nigeria.
authors.forename: John
authors.initials: J
authors.lastname: Idoko
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kanki
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D057915:Drug Substitution; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D009549:Nigeria; D012189:Retrospective Studies; D014505:Urban Population
chemical_list: D044966:Anti-Retroviral Agents
keywords: antiretroviral therapy; regimen durability; substitution; switch