Prevalence and Reasons of Antiretroviral Therapy Switch Among HIV Patients in a large Urban Center

Abstract

Background. Recent studies indicate that the most common reason for antiretroviral therapy (ART) switch is simplification. Patient's adherence to ART is an important factor in HIV management, and the characteristics of the prescribed regimen can affect adherence. Once‐daily regimens, without meal requirements, and minimal adverse event profiles are associated with higher levels of adherence. Clinical data on adherence and patient preference as factors influencing ART switch of recently approved regimens are still not available. Methods. A cross‐sectional observational study was conducted at Jackson Memorial Hospital in Miami, Florida. Subjects were randomly selected from the outpatient HIV clinic between 1 March 2014 and 28 February 2015. Retrospective analysis was then performed to identify patients with a switch in their ART. Clinical background, reasons, and outcome for ART switching were evaluated. Additionally, the association between demographic factors (age, gender, race, and ethnicity), adherence, and patient preference as they relate to the ART switch were assessed. Results. A total of 957 HIV‐infected patients receiving ART were randomly selected. Of those 167 patients met the inclusion criteria by having ART switch during the study period. The prevalence ofART switch in our study population was 17.5%. Ofthe 167 patients, 106 subjects (63.4%) were males and the mean age was 51.9 (±9.4) years. The most commonly reported reason for ART switch was simplification (45.5%) followed by adverse events (30.5%). There were no significant differences in the reasons for ART switching between the different age groups, genders, races, and ethnicities. Further analysis showed that Black or African American HIV‐infected male patients had a higher percentage of poor adherence (33.9%) compared to White HIV‐infected male patients (15.9%) (P=0.04). Also, the percentage ofpoor adherence was higher in females below the age of 50 years (27.9%) compared to those aged 50 years or more (20.8%) (P=0.001). Conclusion. Simplification was the main reason for ART switching followed by adverse events. Poor adherence was higher in Black or African American males. Further studies are necessary to address more detailed demographic data including financial status and education level as they relate to poor adherence to recently approved antiretroviral therapy.