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|Title: ||Discontinuation and modification of highly active antiretroviral therapy in HIV-infected Ugandans: prevalence and associated factors|
|Authors: ||Kiguba, Ronald|
Karamagi, Charles A. S.
|Keywords: ||Discontinuation of antiretrovirals|
Highly Active Antiretroviral Therapy (HAART)
Modification of antiretrovirals
|Issue Date: ||2007 |
|Publisher: ||Lippincott Williams & Wilkins|
|Citation: ||Kiguba, R., Byakika-Tusiime, J., Karamagi, C. A. S., Ssali, F., Mugyenyi, P. & Katabira, E. (2007). Discontinuation and modification of highly active antiretroviral therapy in HIV-infected Ugandans: prevalence and associated factors. Journal of Acquired Immune Deficiency Syndrome, 45(2): 218-223.|
|Abstract: ||Background: Data on discontinuation and modification of highly active antiretroviral therapy (HAART) are scarce among sub-Saharan African populations. We sought to estimate the prevalence and to identify factors associated with these phenomena in our resource-limited setting.
Methods: Patients were recruited into this cross-sectional study from 2 treatment centers in Kampala, Uganda. Discontinuation and modification were assessed by self-report using semi-structured quantitative and unstructured qualitative interviews. Discontinuation was defined as the simultaneous stopping of all antiretrovirals for at least 1 month, and modification as the changing of at least 1 antiretroviral used in an initial HAART regimen. Factors independently associated with each outcome were assessed using multivariate logistic regression.
Results: Of 686 subjects evaluated, 94 (13.7%) had ever discontinued therapy, whereas 175 (25.5%) had ever modified their regimen. The median CD4 count was 175 (interquartile range: 66–297) cells/mL. Factors associated with discontinuation were HAART experience before starting the current regimen (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.13 to 6.25), use of alternative medicines (OR = 2.18, 95% CI: 1.06 to 4.47), hospitalization (OR = 2.36, 95% CI: 1.32 to 4.20), and 1 year or less on HAART (OR = 11.11, 95% CI: 5.00 to 25.00). Modification was associated with more than 3 months’ duration on HAART (OR = 3.13, 95% CI: 1.16 to 8.33) and being unmarried (OR = 1.64, 95% CI: 1.02 to 2.70).
Conclusions: The proportions of discontinuation and modification of antiretroviral therapy (ART) observed in our resource-poor setting pose a challenge to the limited treatment options presently available. Drug cost as a major reason for discontinuation of HAART has major implications for ART programs that charge fees in resource-limited settings.|
|Description: ||© 2007. Lippincott Williams & Wilkins.
This article is available from http://journals.lww.com/jaids/toc/2007/06010|
|Appears in Collections:||Research Articles (Health-Sciences)|
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