Assessment of ART adverse reactions and determinants at primary hospital in Ethiopia

Legese Chelkeba, Gebre Abdissa

Abstract


Background: Much progress has been made in treating HIV infection in the last several years and currently antiretroviral therapy regimens are capable of reducing viral load of undetectable level with a consequent increase in T-lymphocyte, CD4+ counts and reduction in development of opportunistic infections.  Hence, a substantial reduction in HIV associated morbidity and mortality can be attained.  In spite of antiretroviral therapy benefits, adverse reaction to these drugs has been pointed to as one of the main reason for discontinuation, switch and non adherence to antiretroviral therapy.

Methods: A cross-sectional retrospective review of patient record from December 2009-Novomber 2012 was performed to determine the common adverse drug reactions in patients taking ART medications. A sample of 154 who were taking ART medications at Ambo Zonal Hospital was studied and SPSS for windows software versions-16.0 was used for data analysis.

Results: A total of patients with average age of 32.5 years who are taking ART drugs for more than 6 months were studied for the prevalence of adverse reactions. The frequency of GI tract adverse reactions were found to be 75 (48.7%) followed by CNS adverse effects, 55 (35.7%) skin reactions accounted for 29 (18.8%). The least frequently occurred adverse reactions were hematologic reaction (anemia). Patients with low BMI (OR =4.09, p=0.000), having comorbidities (OR=4.566, p=0.000), low CD4+, p=0.002) and treated by TDF/3-TC/EFV (OR=2.087, p=0.001) had high risk of developing adverse drug recreations.

Conclusions: BMI, the presence of other diseases, types of regimen used, duration of therapy and CD4+ lymphocyte less than 400cell/mm3 were strongly associated with the occurrence of adverse drug effects in this study.


Keywords


Adverse drug reactions, ART therapy, Outpatients, Inpatients, Prevention of mother to child transmission

Full Text:

PDF

References


UNICEF ETHIOPIA, AIDS in Ethiopia main indicators, 2007. Available at. http//www.Unicef org/info by country/Ethiopia static, Accessed on 1 May, 2012.

Ministry of Health (MOH) of Ethiopia. Guideline for implementation of antiretroviral therapy. Federal HIV/AIDS Prevention and Control Office. Federal Ministry of Health, 2003.

Treisman GJ, Kaplin AI. Neurologic and psychiatric complications of antiretroviral agents. AIDS 2002;16:1201-15.

WHO TB/HIV a clinical manual, 2nd ed. Geneva Switzerland 2004.

Montessori V, Press N, Harris M, et al. Adverse effect of antiretroviral therapy for HIV infection. CMAJ 2004;170:229-38.

Pádua CA, César CC, Bonolo PF, Acurcio FA, Guimarães MD. Self-reported adverse reactions among patients initiating antiretroviral therapy in Brazil. Braz J Infect Dis 2007;11:20-6.

Obel N, Omland LH, Kronborg G, Larsen CS, Pedersen C, Pedersen G, et al. Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study. PLoS One 2011;6(7):e22698.

Shah I. Adverse effects of antiretroviral therapy in HIV-1 infected children. J Trop Pediatr 2006;52:244-8.

Pádua CA, César CC, Bonolo PF, Acurcio FA, Guimarães MD. High incidence of adverse reactions to initial antiretroviral therapy in Brazil. Braz J Med Biol Res 2006;39:495-505.

McNicholl I. Adverse Events of Antiretroviral Drugs. University of California San Francisco, Available at http://hivinsite.ucsf.edu/InSite?page=ar-05-01. Accessed on 1 May 2012.

Palella FJ Jr, Delaney KM, et al. Declining, morbidity and mortality among patient with advanced human immunodeficiency virus infection. HIV Outpatient study investigators. N Engl Med 1998;338:853-60.

Detels R, Muñoz A, McFarlane G, Kingsley LA, Margolick JB, Giorgi J, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA 1998;280:1497-503.

Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in large urban clinic: risk factors for neurologic failure and adverse drug reaction. Ann Intern Med 1999;131:81-7.

Brinkman K, Smeitink JA, Romijn JA, Reiss P. Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy. Lancet 1999;354:1112-5.

Kebede W. Prevalence of ARV associated adverse effects and potential management strategies undertaken among patients taking ART in St. Peter TB specialized hospital, Addis Ababa, Ethiopia. 2011;14-8.

Stewart R, Padrath A, Banford L. Providing antiretroviral treatment in southern Africa. Published by health system trust, 2004;132:48-50. Available at www.hst.org.za/publications/608. Accessed 1 May 2012.

Study Group on Death Rates at High CD4 Count in Antiretroviral Naive Patients, Lodwick RK, Sabin CA, Porter K, et al. Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per microL in Europe and North America: a pooled cohort observational study. Lancet 2010;376:340-5.

Lohse N, Hansen AB, Pedersen G, et al. Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007;146:87-95.

Sharma A, Vora R, Modi M, et al. Adverse effects of antiretroviral treatment. Indian J Dermatol Venereol Leprol 2008;74:234-7.

Bhat VG, Ramburuth M, Singh M, Titi O, Antony AP, Chiya L, et al. Factors associated with poor adherence to anti-retroviral therapy in patients attending a rural health centre in South Africa. Eur J Clin Microbiol Infect Dis 2010;29:947-53.

Uzochukwu BS, Onwujekwe OE, Onoka AC, Okoli C, Uguru NP, Chukwuogo OI. Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria. Health Policy Plan 2009;24:189-96.