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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
Authors: Awoke, Tadesse
Worku, Alemayehu
Kebede, Yigzaw
KASIM, Adetayo 
Birlie, Belay
Zuma, Khangelani
Issue Date: 2016
Source: PLOS ONE, 11(12) (Art N° e0168323)
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%Cl: 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 degrees%Cl: 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.
Notes: [Awoke, Tadesse; Kebede, Yigzaw] Univ Gondar, Epidemiol & Biostat, Gondar, Ethiopia. [Worku, Alemayehu] Univ Addis Ababa, Sch Publ Hlth, Addis Ababa, Ethiopia. [Kasim, Adetayo] Univ Durham, Wolfson Res Inst, Durham, England. [Birlie, Belay] Jimma Univ, Biostat, Jimma, Ethiopia. [Braekers, Roel; Shkedy, Ziv] Hasselt Univ, I BioStat, Diepenbeek, Belgium. [Zuma, Khangelani] Hlth Sci Res Council, Pretoria, South Africa.
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ISSN: 1932-6203
e-ISSN: 1932-6203
DOI: 10.1371/journal.pone.0168323
ISI #: 000392842900034
Rights: Copyright: © 2016 Awoke et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Category: A1
Type: Journal Contribution
Validations: ecoom 2018
Appears in Collections:Research publications

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