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J Int Assoc Provid AIDS Care. 2015 Jul-Aug;14(4):348-54. doi: 10.1177/2325957414565508. Epub 2015 Jan 7.

Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria.

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  • 1Jos University Teaching Hospital, Jos, Nigeria
  • 2Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • 3University of Jos/Jos University Teaching Hospital, Jos, Nigeria.
  • 4Jos University Teaching Hospital, Jos, Nigeria.
  • 5University of Jos, Jos, Nigeria.
  • 6AIDS Prevention Initiative in Nigeria, Ltd./Gte, Lagos, Nigeria.
  • 7National Agency for the Control of AIDS (NACA), Abuja, Nigeria.
  • 8Harvard School of Public Health, Boston, MA, USA.



We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria.


Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis.


Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count≤100 cells/mm3 (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43).


Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.


antiretroviral therapy; regimen durability; substitution; switch

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