title: Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi.
abstract: Lighthouse Trust in Lilongwe, Malawi serves approximately 25,000 patients with HIV antiretroviral therapy (ART) regimens standardized according to national treatment guidelines. However, as a referral centre for complex cases, Lighthouse Trust occasionally treats patients with non-standard ART regimens (NS-ART) that deviate from the treatment guidelines. We evaluated factors contributing to the use of NS-ART and whether patients could transition to standard regimens.
  
  
  
  This was a cross-sectional study of all adult patients at Lighthouse Trust being treated with NS-ART as of February 2012. Patients were identified using the electronic data system. Medical charts were reviewed and descriptive statistics were obtained.
  
  
  
  One hundred six patients were initially found being treated with NS-ART, and 92 adult patients were confirmed to be on NS-ART after review. Mean patient age was 42.4 ± 10.3 years, and 52 (57%) were female. Mean duration of treatment with the NS-ART being used at the time of data collection was 2.1 ± 1.5 years. Eight patients (9%) were on modified first-line NS-ART and 84 (91%) were on modified second-line NS-ART, with 90 patients (98%) having multiple factors contributing to NS-ART use. Severe toxicity from one medication contributed in 28 cases (30%) and toxicity from multiple medications contributed in 46 cases (50%), while 22 patients (24%) were transitioned to NS-ART following a stockout of their original medication. Following clinical review, 84 patients (91%) were transitioned to standard regimens, and eight (9%) were maintained on NS-ART because of incompatibility of their clinical features with the latest national guidelines.
  
  
  
  Primary factors contributing to NS-ART use were medication toxicities and medication stockouts. Most patients were transitioned to standard regimens, although the need for NS-ART remains.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Barnett
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: T
authors.initials: T
authors.lastname: Chaweza
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Tweya
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: W
authors.initials: W
authors.lastname: Ngambi
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Phiri
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: M C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000600:supply & distribution / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use; D008295:Malawi; D008297:Male; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use; D018119:Stavudine / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D035502:Trust; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine