ABSTRACT

In the Coastal region of Kenya, Mombasa County has the highest HIV prevalence (11.1%) of the estimates based on Kenya AIDS Progress Report of 2014. Limited data exist on effective regimen strategies to manage HIV/AIDS among adults in Kenya. Safe alternative HAART regimens are not currently a viable option for many, especially infected patients in Sub-Saharan Africa. The objective of this study was to compare the effectiveness of Efavirenz and Nevirapine based First-line HIV treatment in patients attending comprehensive care centre in Mombasa. This was a prospective comparative study. The target population was HIV positive adult patients eligible for HAART. A total of 251 patients were enrolled in the study and followed up for 12 months. All ARV naive patients with CD4 count < 350/ul with WHO stage 3 or 4 and eligible for HAART were randomly selected and enrolled into either of the two treatment groups. HIV infected adult patients were randomised into Efavirenz and Nevirapine based regimens (D4T/3TC/EFV and D4T/3TC/NVP) and followed up for a period of twelve months. Laboratory tests were done by collecting 10mls of blood from each patient every three months and tested for Haemoglobin, Liver enzyme test (ALT), Creatinine and CD4 cell count. Clinical examination included physical examination, measurement of body weight and vital signs (Temperature, Blood Pressure and Pulse). Data analysis was done using SPSS Version 17.0 package to perform one way ANOVA comparing more than two means, followed by Post hoc (Student Newman Keul). Independent t-test was used to calculate difference between the two treatment groups. In both statistics, 95% confidence level was used, where P<0.05 meant significant difference. The study showed that first-line regimens of Efavirenz and Nevirapine were effective in suppressing HIV/AIDS infection with significant improvement in CD4 count (P<0.05). There was also improvement in haemoglobin levels and body weight among the patients on both regimens in the study. However, elevation of ALT and Creatinine were noted in both treatment groups, but this did not warrant drug discontinuation (P>0.05). Efavirenz based regimen appeared to be superior to Nevirapine based regimen on CD4+ profiles and renal function (P<0.05). There was no significant difference in haemoglobin levels, body weight and ALT enzyme for patients on both treatment groups although these parameters increased with time for patients in both groups throughout the study (P>0.05). The findings demonstrated that D4TC/3TC/EFV and D4TC/3TC/NVP combinations were safe, well tolerated and effective in increasing CD4 Cell counts and suppressing HIV progression in advanced HIV infected patients as well as improvement in body weight gain and anaemia. Renal function and Liver function should therefore be monitored on a regular basis in patients with HIV receiving any antiretroviral agent.