Antiretroviral durability and tolerability in HIV-infected adults living in urban Kenya

Abstract

Background: Insufficient data exist on the durability and tolerability of first-line antiretroviral therapy (ART) regimens provided by HIV treatment programs implemented in developing countries.

Methods: Longitudinal observation of clinical, immunologic, and treatment parameters of all HIV-infected adult patients initiated on ART was performed at Saint Mary's Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.

Results: A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration was 350 days (11.6 months). Significant improvements in clinical and immunologic status were noted after 12 months of therapy. ART switches occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12 months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis treatment interactions (28.1%) were the most frequent reasons for ART switch. Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]: 1.28 to 1.98; P<0.01) and a CD4 count<or=100 cells/mm3 (HR=1.20, CI: 1.01 to 1.43; P=0.04) were independent predictors of ART switch. ART-related clinical toxicity occurred in 341 (26.5%) patients. Peripheral neuropathy was reported most frequently (20.7%). A CD4 count<or=100 cells/mm3 was an independent predictor of clinical toxicity.

Conclusions: Excellent clinical and immunologic responses to ART were observed in this urban Kenyan population; however, frequent switches in ART among medication classes because of toxicity or drug interactions may limit the durability of these responses.