Rates of Switching Antiretroviral Drugs in a Primary Care Service in South Africa before and after Introduction of Tenofovir

摘要: INTRODUCTION Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options introduce challenges such as increased cost, monitoring adherence difficulties. Patterns of switches from stavudine (d4T) zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns risk factors for these antiretroviral drugs in adults. METHOD retrospective cohort included HIV positive, (ART) naive adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) a non-nucleoside inhibitor. Follow-up was censored at first change analysis focused NRTI only. RESULTS Between September 2002 April 2011, 5095 initiated Gugulethu. comprised 948 subjects TDF, 3438 d4T 709 AZT. Virological suppression rates 1 year, switching due to virological failure overall losses programme were similar across three groups. TDF had lowest incidence rate (2.6 per 100 P/Ys) compared 17.9 8.5 P/Ys Adverse reactions (ADRs) accounted majority d4T. Multivariate showed that increasing age, female sex exposure associated hazard substitution ADRs. Conversely, substantially lower (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION Regimen patients exposed AZT, suggesting all equally effective. However, better tolerated