Incidence Rate and Factors Associated with Antiretroviral Therapy Regimen Change among Adult HIV Patients at Ngoerah Hospital Bali, Indonesia.

Abstract

Background: The human immunodeficiency virus (HIV) epidemic remains a major global health concern. While antiretroviral therapy (ART) has significantly improved survival rates, regimen changes during long-term treatment are common and may impact clinical outcomes. Data regarding the incidence rate and determinants of ART regimen changes among people living with HIV (PLHIV) in Bali, Indonesia, remain limited.

Material and methods: This retrospective cohort study included adult PLHIV receiving ART at Ngoerah Hospital, Bali, Indonesia, from July 2004 to December 2023. A total of 265 eligible patients were selected through systematic random sampling. Multivariable Cox Regression was used to identify factors associated with regimen change.

Results: During the study period, the incidence rate of ART regimen changes was 2.22 per 100 person-years (95% confidence interval [CI], 1.760-2.802), with 3,196.7 person-years of observation, and the median follow-up duration for patients was 11.7 years (interquartile range, 11.1-13.7). The median age was 45 years, and the majority were male (64.5%). In multivariate analysis, nevirapine (NVP)-based initial regimens (adjusted hazard ratio [aHR], 1.853; 95% CI, 1.031-3.329; P=0.039) and baseline CD4 < 200 cells/µL (aHR, 1.940; 95% CI, 1.215-3.098; P=0.005) were significantly associated with regimen change. In addition, most regimen changes (87.3%) occurred after more than ten years of treatment. The primary reasons for regimen change were treatment failure (36.6%), medication stockout (23.9%), and adverse effects (21.1%).

Conclusion: NVP-based regimens and low baseline CD4 counts were key factors of regimen change. Continuous monitoring, timely detection of treatment failure, and the use of more durable regimens are essential to improve long-term treatment outcomes for the HIV patients in our outpatient clinic in Bali, Indonesia.