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 ≤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 ≤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.