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The patterns and reasons for antiretroviral therapy (ART) drug substitutions are poorly described in resource-limited settings.

Time to and reason for drug substitution were recorded in treatment-naive adults receiving ART in two primary care treatment programmes in Cape Town. The cumulative proportion of patients having therapy changed because of toxicity was described for each drug, and associations with these changes were explored in multivariate models.

Analysis included 2,679 individuals followed for a median of 11 months. Median CD4⁺ T-cell count at baseline was 85 cells/μl. Mean weight was 59 kg, mean age was 32 years and 71% were women. All started non-nucleoside reverse transcriptase inhibitor-based ART (60% on efavrienz) and 75% started on stavudine (d4T). After 3 years, 75% remained in care on-site, of whom 72% remained on their initial regimen …