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Objective: To determine the prevalence and factors associated with ART modification among HIV patients on 1 st line therapy attending a large Teaching Hospital in Kenya. Methods: A retrospective cross-sectional clinical record review. All patients who commenced ART from January 2005 to June 2011 and had at least 1 follow-up visit were evaluated. Baseline data, including socio demographic and clinical variables was collected using a standard chart abstraction tool. Results: Out of 1,022 patients 658 (64.4%) were female and the mean age of study participants was 37.8years. The median CD4+ count at initiating ART was 149cells/ml (IQR 55-248). The most common first-line regimens were stavudine (d4T) and zidovudine (AZT) based at 63% and 13.3% respectively. 1775 patients modified their initial ART at a rate of 36.8% (95% confidence interval [CI] 35.4-38.2%). The commonest reasons for modifying ART were toxicity accounting for 66.5%, treatment failure 12.9%, and co-morbid conditions 9.4%. The most frequent toxic effects were lipodystrophy (41.3%), peripheral neuropathy (10.6%) and anemia (5.9%). The median time to modifying therapy was 28 months (IQR 15-41). Immunological outcome of modification pre and post-modification was 335 cells/ml (IQR 8-497) to 399 cells/ ml (IQR 257-611) with p=0.001. In the multivariate analysis WHO clinical stage III (odds ratio [OR], 2.9 [95%CI 1.7-2.8]; p=0.001), and IV (5.5 [2.8-11.0]; p=0.001), CD4+ count ≤200cells/ml (2.4 [1.54.0]; p=0.001) were associated with likelihood of modifying ART. Conclusion: There was a high rate of ART modification in this study. Drug toxicity was the most frequent reason for treatment modification; however it did not affect treatment success. The median duration to modification of first-line ART was 28 months. Low CD4+ count, increasing WHO stage and longer duration of ART was associated with likelihood of ART modification.

Modification of Antiretroviral Therapy in a Cohort Study of HIV-Infected Patients Attending an Urban Teaching Hospital in Kenya