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Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa

Introduction: Tenofovir-Emtricitabine-Efavirenz (TEE) fixed-dose-combination (FDC) has been recommended since 2013 as the first-line antiretroviral therapy (ART) for treating HIV for people living with the virus (PLWH) in South Africa. More evidence has emerged to show long term adverse effects of E...

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Main Author: Huang, David
Other Authors: Namane, Mosedi
Format: Thesis
Language:English
Published: Department of Public Health and Family Medicine 2020
Subjects:
Family Medicine
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_version_ 1867613181746085888
access_status_str Open Access
author Huang, David
author2 Namane, Mosedi
author_browse Huang, David
Namane, Mosedi
author_facet Namane, Mosedi
Huang, David
author_sort Huang, David
collection Thesis
description Introduction: Tenofovir-Emtricitabine-Efavirenz (TEE) fixed-dose-combination (FDC) has been recommended since 2013 as the first-line antiretroviral therapy (ART) for treating HIV for people living with the virus (PLWH) in South Africa. More evidence has emerged to show long term adverse effects of Efavirenz(EFV). This study assesses the adverse effect profile of TEE by determining the event rate of switching from co-formulation and the reason for such switch. Method: This retrospective cohort study involved the review of the records of HIV infected adults receiving the TEE fixed dose combination ART over a 5-year period. All adult patients 18 years age or above, non-pregnant, previous ART treatment naïve that started TEE during 1 September 2014 and 31 August 2019 were included. Follow-up was censored at first drug change, transfer-out, loss-of-follow-upon deaths. Results: Two-thousand-and-ninety subjects were newly initiated on ART and 1961 met the inclusion criteria. Ninety-four patients (4.8%) had drug-changes prior censor date whereas 1867 remained on TEE. Forty-seven (50%) were single drug changes due to adverse effects and the other 50% were regimen changes as result of virological failure. The median time to change for TDF and EFV were 0,24 and 1,26 person years respectively. The median time to change for virological failure was 1,02 years. Patients with baseline CD4 count less than 200 cells/uL has higher risk of switch event. The proportion of poor outcome (death or loss to follow up) in patients with no drug switches (8,78%) was similar to those of patients with drug changes(8,5%). Conclusion: Tenofovir-Emtricitabine-Efavirenz combination treatment remains an excellent first-line ART option for people living with HIV, with a low rate of substitutions due to toxicity and high virological suppression. With the advent of Tenofovir-Lamivudine-Dolutegravir combination regimen as the preferred first-line, clinicians should remain cognisant of Tenofovir adverse drug effects.
format Thesis
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institution University of Cape Town (South Africa)
language eng
last_indexed 2026-06-10T12:32:03.909Z
license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2020
publishDateRange 2020
publishDateSort 2020
publisher Department of Public Health and Family Medicine
publisherStr Department of Public Health and Family Medicine
record_format dspace
source_str UCTD — University of Cape Town Open Access Repository
spelling oai:open.uct.ac.za:11427/32400 Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa Huang, David Namane, Mosedi Orrell, Catherine Family Medicine Introduction: Tenofovir-Emtricitabine-Efavirenz (TEE) fixed-dose-combination (FDC) has been recommended since 2013 as the first-line antiretroviral therapy (ART) for treating HIV for people living with the virus (PLWH) in South Africa. More evidence has emerged to show long term adverse effects of Efavirenz(EFV). This study assesses the adverse effect profile of TEE by determining the event rate of switching from co-formulation and the reason for such switch. Method: This retrospective cohort study involved the review of the records of HIV infected adults receiving the TEE fixed dose combination ART over a 5-year period. All adult patients 18 years age or above, non-pregnant, previous ART treatment naïve that started TEE during 1 September 2014 and 31 August 2019 were included. Follow-up was censored at first drug change, transfer-out, loss-of-follow-upon deaths. Results: Two-thousand-and-ninety subjects were newly initiated on ART and 1961 met the inclusion criteria. Ninety-four patients (4.8%) had drug-changes prior censor date whereas 1867 remained on TEE. Forty-seven (50%) were single drug changes due to adverse effects and the other 50% were regimen changes as result of virological failure. The median time to change for TDF and EFV were 0,24 and 1,26 person years respectively. The median time to change for virological failure was 1,02 years. Patients with baseline CD4 count less than 200 cells/uL has higher risk of switch event. The proportion of poor outcome (death or loss to follow up) in patients with no drug switches (8,78%) was similar to those of patients with drug changes(8,5%). Conclusion: Tenofovir-Emtricitabine-Efavirenz combination treatment remains an excellent first-line ART option for people living with HIV, with a low rate of substitutions due to toxicity and high virological suppression. With the advent of Tenofovir-Lamivudine-Dolutegravir combination regimen as the preferred first-line, clinicians should remain cognisant of Tenofovir adverse drug effects. 2020-11-19T11:12:38Z 2020-11-19T11:12:38Z 2020 2020-11-19T07:56:47Z Master Thesis Masters MMed http://hdl.handle.net/11427/32400 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences
spellingShingle Family Medicine
Huang, David
Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
thesis_degree_str Master's
title Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
title_full Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
title_fullStr Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
title_full_unstemmed Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
title_short Rates of Switching First-Line Antiretroviral Regimen Tenofovir-Emtricitabine-Efavirenz combination in a Primary Care Service in South Africa
title_sort rates of switching first line antiretroviral regimen tenofovir emtricitabine efavirenz combination in a primary care service in south africa
topic Family Medicine
url http://hdl.handle.net/11427/32400
work_keys_str_mv AT huangdavid ratesofswitchingfirstlineantiretroviralregimentenofoviremtricitabineefavirenzcombinationinaprimarycareserviceinsouthafrica

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