Assessment of ART switching rates in HIV patients at a Nigerian hospital
Journal name: World Journal of Pharmaceutical Research
Original article title: Assessment of switching rate of antiretroviral therapy from first-line to second line among hiv infected adults in nigerian tertiary hospital, causes and determinant factors
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Mgbahurike A. A. and Jonah G. I.
World Journal of Pharmaceutical Research:
(An ISO 9001:2015 Certified International Journal)
Full text available for: Assessment of switching rate of antiretroviral therapy from first-line to second line among hiv infected adults in nigerian tertiary hospital, causes and determinant factors
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
Doi: 10.20959/wjpr201912-15933
Download the PDF file of the original publication
Summary of article contents:
Introduction
The provision of antiretroviral therapy (ART) for HIV-infected individuals in sub-Saharan Africa has significantly increased over the past decade. However, as more patients are exposed to ART, the risks of resistance and treatment failure have become pertinent concerns. Switching from first-line to second-line ART is often recommended by the World Health Organization (WHO) for patients experiencing virologic failure. This study focused on examining the rate of switching among HIV-infected adults at the University of Port Harcourt Teaching Hospital in Nigeria, identifying the causes and determinants that prompted such transitions.
Rate of Switching and Patient Demographics
In this retrospective cohort study, data on 239 HIV-infected patients were analyzed to determine the switching rate from first-line to second-line ART over a ten-year period (2006-2016). Of the patients assessed, 24 (10.04%) switched to second-line therapy, resulting in a switch rate of 22.9 per 100 person-years. The demographic analysis indicated that the majority of switched patients were female (79.2%) and predominantly aged 40-49 years. Notably, the mean age of those who switched was 41.8 years, and most patients transitioned after spending 2 to 4 years on first-line ART.
Reasons for Switching
The study highlighted various reasons for patients switching from first-line to second-line ART. A significant proportion—37.5%—of the switches had no documented reason, which raises concerns about the lack of clinical documentation practices. Other reasons included side effects (20.8%), toxicity or adverse effects (16.7%), treatment failure (16.7%), and pregnancy (8.3%). The predominance of undisclosed reasons suggests potential gaps in understanding patient experiences or clinician reporting, underscoring the need for better documentation in clinical practice.
Clinical Outcomes and Monitoring Challenges
The clinical outcomes of switched patients revealed minimal change in mean CD4 cell counts between ART initiation (212.3 cells/mm³) and switching (221.3 cells/mm³), suggesting that immunologic responses may not directly correlate with the decision to switch therapies. Furthermore, the study noted significant limitations in monitoring technologies, as viral load testing—a key indicator for virologic failure—was not readily available in the facility. Consequently, switching decisions were often made based on clinical observations or CD4 counts rather than virologic data, leading to potentially misguided treatment changes.
Conclusion
Overall, this study identified a switch rate of 22.9 per 100 person-years among HIV-infected patients at the University of Port Harcourt Teaching Hospital, with a significant number of switches occurring without documented reasons. The findings emphasize the importance of thorough clinical documentation and effective monitoring strategies to enhance treatment outcomes for HIV patients. Furthermore, the lack of access to advanced viral load testing poses a substantial challenge to achieving optimal care, necessitating concerted efforts to improve health service delivery in resource-limited settings.
FAQ section (important questions/answers):
What was the objective of the study on antiretroviral therapy?
The study aimed to determine the rate of switching from first-line to second-line antiretroviral therapy among HIV-infected patients and identify the determinants and timing of such switches.
What percentage of patients switched from first-line to second-line ART?
Out of 239 patients assessed, 24 patients, accounting for 10.04%, switched from first-line to second-line ART during the study period.
What were the primary reasons for patients switching therapy?
The primary reasons for switching included side effects (20.8%), toxicity/adverse effects (16.7%), treatment failure (16.7%), pregnancy (8.3%), and 37.5% had no documented reason for the switch.
What was the average duration of patients on first-line therapy before switching?
Most patients (62.5%) switched after spending 2 to 4 years on their first-line antiretroviral therapy.
Was virologic failure a significant reason for switching therapy?
The study found that switches were rarely based on virologic failure, primarily due to limited access to viral load testing in the facility.
What was the mean age of patients who switched therapy?
The mean age of patients who switched from first-line to second-line ART was 41.8 years, with the majority being within the age range of 40 to 49 years.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Assessment of ART switching rates in HIV patients at a Nigerian hospital”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Line:
The term 'Line' pertains to the classification of antiretroviral therapy (ART) based on treatment stages. In this context, it distinguishes between first-line and second-line therapies. First-line ART is the initial treatment regimen, while second-line art usually involves alternative medications used when the first-line fails or causes adverse effects.
2) Study (Studying):
The word 'Study' refers to the systematic investigation conducted to assess the switching rate of HIV patients from first-line to second-line ART. It encompasses the retrospective cohort analysis carried out over ten years to understand treatment efficacy and patient health outcomes in the given population.
3) Drug:
The term 'Drugs' collectively encompasses all medications referenced in the antiretroviral therapy regimen. These include both first-line and second-line drugs, each with distinct mechanisms of action and profiles in terms of efficacy, side effects, and patient tolerability.
4) Reason:
The term 'Reason' denotes the underlying causes that prompt the switching of HIV patients from first-line to second-line ART. Understanding these reasons is vital for healthcare providers to improve treatment protocols, address patient needs, and enhance adherence through better management of adverse effects.
5) Toxicity:
The word 'Toxicity' relates to the adverse side effects or negative reactions that medications can have on the body. In the study, toxicity is a significant factor leading to patients switching to second-line ART, impacting overall treatment outcomes and patient quality of life.
6) Table:
In the context of the study, 'Table' refers to the organized presentation of data, summarizing patient demographics, clinical characteristics, and results about the switching rates. Tables serve as key tools to visualize and communicate significant findings efficiently within research documents.
7) Teaching:
The word 'Teaching' involves the educational component tied to healthcare practices. The study highlights the importance of educating patients on adherence to ART, the significance of monitoring, and how understanding treatment options can lead to better health outcomes in managing HIV.
8) Male:
The term 'Male' signifies one of the gender classifications among the study's participants. Gender disparities can provide insights into treatment patterns, adherence behaviors, and health outcomes, influencing the research findings on ART switching rates within the population.
9) Science (Scientific):
Similar to 'Sciences,' 'Science' signifies the systematic knowledge governing the principles and practices of medicine in treating HIV and understanding the mechanisms of therapy. It emphasizes the evidence-based approach necessary for developing treatment guidelines and improving patient care.
10) Viru:
This appears to be a truncated form of 'Virus', referring to HIV in this study. Understanding the virus's characteristics is crucial in developing effective antiretroviral therapies, as varying drug regimens target different stages of the viral life cycle.
11) Pur:
The word 'Poor' is often associated with inadequate treatment outcomes or health conditions. In the context of this study, it could relate to poor adherence, resulting in treatment failure, or poor access to healthcare resources, impacting ART management in the region.
12) Transmission:
The term 'Transmission' refers to the spread of HIV, which is critical to understanding epidemiological trends. Preventing transmission is a key component of HIV treatment, reinforcing the need for effective ART and the implications of treatment adherence in controlling the epidemic.
13) Discussion:
In the study, 'Discussion' refers to the section where findings are analyzed, interpreted, and contextualized within existing research. This dialogue is essential for deriving conclusions about the switching rates and factors influencing ART decisions among the studied population.
14) Education:
The term 'Education' underscores the importance of informing patients about their treatment regimens, potential side effects, and the significance of adherence to ART. Enhanced patient education can lead to better health outcomes and reduced switching rates.
15) Pregnant:
The word 'Pregnant' is significant in the context of HIV treatment, as pregnancy can influence the choice of ART regimens and may necessitate a switch due to specific health considerations for both the mother and child.
16) Account:
The term 'Account' refers to the recorded information regarding patients’ health status and treatment adherence. Maintaining accurate accounts in patient records enhances the assessment and continuity of care, as well as stratifying patient data for research purposes.
17) Allergy:
In the study context, 'Allergy' pertains to potential adverse reactions some patients might experience from ART. Monitoring and managing allergies are crucial in deciding whether to continue or switch therapies for individuals undergoing treatment.
18) India:
The term 'India' likely references comparative studies or data relevant to HIV treatment practices in the country. Understanding treatment outcomes in different geographical contexts, including India, allows for better comparative analysis and may highlight varied approaches in ART deployment.
19) Visit:
The word 'Visit' indicates patient appointments scheduled for monitoring health, discussing treatment plans, or refilling medications. Regular visits are crucial for assessing adherence, managing side effects, and ensuring the effectiveness of ART.
20) Rich (Rch):
The term 'Rich' may be used in comparative studies regarding healthcare resources available to populations affected by HIV. Understanding the implications of wealth in accessing treatment and healthcare services can provide insights into ART management discrepancies.
21) Road:
In this context, 'Road' could refer to the geographical location of the healthcare facility. Accessibility to healthcare services, including ART, can be significantly affected by local infrastructure, impacting patient adherence and health outcomes.
22) Life:
The word 'Life' signifies the broader implications of health interventions. Managing HIV through effective ART not only extends patients' life expectancy but also enhances their quality of life, emphasizing the overall goal of healthcare in improving well-being.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Assessment of ART switching rates in HIV patients at a Nigerian hospital’. Further sources in the context of Science might help you critically compare this page with similair documents:
Data collection, Adverse drug reaction, Viral load, Demographic Data, Research article, Ethical approval, Sample size determination, Treatment failure, Retrospective cohort study, Antiretroviral therapy, Protease inhibitor, Side effect, Patient adherence, Poor adherence.