Reasons for modifications of antiretroviral therapy among patients living with HIV at a tertiary care hospital

Abstract

Background: Antiretroviral therapy (ART) is frequently modified and alternative regimens are used to overcome the acute and chronic toxicities, drug resistance, cost, unavailability of the stock, comorbidities and treatment failure. In a resource-limited setting like Nepal, it is important to determine the magnitude and reasons for ART regimen modifications. The objective of the study was to find the reasons for modification in ART regimens among patients living with HIV (PLHIV).

Methods: It was a cross-sectional study conducted among PLHIV at ART Clinic, B.P. Koirala Institute of Health Sciences Dharan, Nepal from January to March 2019. The information on socio-demographics, duration of ART therapy, mode of HIV transmission, the latest ART regimen and reason for its modification were collected on a self-designed proforma through the review of patients’ health cards and a face-to-face interview. Descriptive statistics were calculated.

Results: Out of 521 patients, modification of the ART regimen was made in 83 (15.9%) patients. The mean age (± standard deviation) was 36.57 ± 7.90 years. The majority of the patients (66.3%) were in the age group of 31-45 years and 50 (60.2%) were male. One-third of the patients (32.5%) were taking Tenofovir+Lamivudine+Efavirenz. Adverse drug reaction (82.2%) was the commonest cause of ART regimen modification. Anemia (24.1%) was the most common adverse drug reaction responsible for ART regimen modification.

Conclusion: ART modification had occurred at a lower rate in our setting and anemia was the most common reason for modification in the ART regime. The study findings might help the clinicians for the appropriate management of the PLHIV