title: Modeling Outcomes of First-Line Antiretroviral Therapy and Rate of CD4 Counts Change among a Cohort of HIV/AIDS Patients in Ethiopia: A Retrospective Cohort Study.
abstract: BACKGROUND
  Antiretroviral therapy has shown to be effective in reducing morbidity and mortality in patients infected with HIV for the past couples of decades. However, there remains a need to better understand the characteristics of long-term treatment outcomes in resource poor settings. The main aim of this study was to determine and compare the long-term response of patients on nevirapine and efavirenz based first line antiretroviral therapy regimen in Ethiopia.
  
  
  METHODS
  Hospital based retrospective cohort study was conducted from January 2009 to December 2013 at University hospital located in Northwest Ethiopia. Human subject research approval for this study was received from University of Gondar Research Ethics Committee and the medical director of the hospital. Cox-proportional hazards model was used to assess the effect of baseline covariates on composite outcome and a semi-parametric mixed effect model was used to investigate CD4 counts response to treatments.
  
  
  RESULTS
  A total of 2386 HIV/AIDS naive patients were included in this study. Nearly one-in-four patients experienced the events, of which death, lost to follow up, treatment substitution and discontinuation of Non-Nucleoside Reverse Transcriptase Inhibitors(NNRTI) accounted: 99 (26.8%), 122 (33.0%), 137 (37.0%) and 12 (3.2%), respectively. The hazard of composite outcome on nevirapine compared with efavirenz was 1.02(95%CI: 0.52-1.99) with p-value = 0.96. Similarly, the hazard of composite outcome on tenofovir and stavudine compared with zidovudine were 1.87 (95%CI: 1.52-2.32), p-value < 0.0001 and 1.72(95% CI: 1.22-2.32), p-value = 0.002, respectively. The rate of CD4 increase in response to treatment was high during the first 10 months and stabilized later.
  
  
  CONCLUSIONS
  This study revealed that treatment responses were comparable whether nevirapine or efavirenz was chosen to initiate antiretroviral therapy for HIV/AIDS patients in Ethiopia. There was significant difference on risk of composite outcome between patients who were initiated with Tenofovir containing ART regimen compared with zidovudine after controlling for NNRTI drug combinations.
authors.affiliation: Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.
authors.forename: Tadesse
authors.initials: T
authors.lastname: Awoke
authors.affiliation: School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Worku
authors.affiliation: Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.
authors.forename: Yigzaw
authors.initials: Y
authors.lastname: Kebede
authors.affiliation: Wolfson Research Institute, Durham University, Durham, United Kingdom.
authors.forename: Adetayo
authors.initials: A
authors.lastname: Kasim
authors.affiliation: Biostatistics, Jimma University, Jimma, Ethiopia.
authors.forename: Belay
authors.initials: B
authors.lastname: Birlie
authors.affiliation: I-BioStat, Hasselt University, Diepenbeek, Belgium.
authors.forename: Roel
authors.initials: R
authors.lastname: Braekers
authors.affiliation: Health Sciences Research Council, Pretoria, South Africa.
authors.forename: Khangelani
authors.initials: K
authors.lastname: Zuma
authors.affiliation: I-BioStat, Hasselt University, Diepenbeek, Belgium.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Shkedy
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D019380:Anti-HIV Agents