Discontinuation of standard first-line antiretroviral therapy in a cohort of 1434 Malawian children

Table 1 Reasons for discontinuation of standard first-line ART regimen

Reason for discontinuation of standard first-line ART (d4T/3TC/NVP) ^a	Number of patients (male/female)	Proportion of total cohort of 1434 patients (%)
Toxicity	28 (17/11)	1.95%
• Nevirapine - rash (unknown WHO grade)	1 (0/1)	0.07%
• Nevirapine - rash (WHO grade II)	5 (3/2)	0.35%
• Nevirapine - rash (WHO grade III)	4 (2/2)	0.28%
• Nevirapine - Stevens-Johnson syndrome (WHO grade IV) ^b	5 (4/1)	0.35%
• Nevirapine - hepatitis (WHO grade IV) ^c	2 (2/0)	0.14%
• Nevirapine - total	17 (11/6)	1.19%
• Stavudine - pancreatitis (WHO grade III)	3 (2/1)	0.21%
• Stavudine - pancreatitis (WHO grade IV)	2 (1/1)	0.14%
• Stavudine - lactic acidosis (unknown WHO grade)	1 (1/0)	0.07%
• Stavudine - lactic acidosis (WHO grade III)	3(1/2)	0.21%
• Stavudine - peripheral neuropathy (unknown WHO grade)	1 (0/1)	0.07%
• Stavudine toxicity - peripheral neuropathy (WHO grade III)	1 (1/0)	0.07%
• Stavudine - total	11 (6/5)	0.76%
First-line failure ^d	22 (16/6)	1.53%
Other ^e	4 (3/1)	0.28%

^aToxicity grading per 2006 WHO guidelines (I-mild, II-moderate, III-severe, IV-severe, potentially life-threatening).
^bOne patient died from drug-induced SJS.
^cOne patient had a negative Hepatitis B surface antigen test documented. Serologies for other viral hepatitides are not available in Malawi. Neither patient was on concurrent TB treatment.
^dAll patients in our cohort had confirmed virologic failure on first-line ART.
^eFour Kaposi's sarcoma patients had been placed on a protease inhibitor-based regimen for possible antiangiogenic effects.