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Bassi PU, Gashau W. Impact of serious adverse drug reactions on the quality of life of patients on highly active antiretroviral therapy in Maiduguri, northeast Nigeria: a four-year retrospective study. AIDS Care 2024:1-10. [PMID: 39024657 DOI: 10.1080/09540121.2024.2365857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 06/03/2024] [Indexed: 07/20/2024]
Abstract
ABSTRACTSerious adverse drug reactions (sADRs) have a serious impact on the progress being made in providing antiretroviral therapy. The presence of HIV/AIDS and its complications associated with sADRs, has a negative effect on the quality of life (QoL) of people living with HIV/AIDS (PLWHA). This was a descriptive retrospective cohort study of 400 adult HIV patients in which the QoL of PLWHA with sADRs was compared to patients that did not experience ADR who had been on antiretroviral therapy (ART) was followed up for 48 months using the WHOQOL-HIV BREF to measure QoL. Out of 400 patients, 373 (93.25%) respondents completed the study with an overall mean age was 40.8 years (SD ± 8.64). One hundred and ninety-nine patients (53.4%) reported to have experiencing sADR. The response consistently showed significantly higher mean scores in the QoL of patients who had no ADRs in the psychological, social and environments state of health domains compared to those who had ADRs with mean scores (P = 0.000, 0.037 and 0.028), respectively. This study revealed significantly higher scores in patients who had no ADRs compared to those who had ADRs. Low QoL due to serious ADR may add additional burden to HIV disease and complications, and the related discrimination often faced by PLWHA. This study would help clinicians pay serious attention to identifying and promptly managing ADR.
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Affiliation(s)
- Peter U Bassi
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - W Gashau
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
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Nyame L, Hu Y, Xue H, Fiagbey EDK, Li X, Tian Y, Fan L, Du W. Variation of adverse drug events in different settings in Africa: a systematic review. Eur J Med Res 2024; 29:333. [PMID: 38880895 PMCID: PMC11181533 DOI: 10.1186/s40001-024-01934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Adverse drug events (ADEs) represent challenges affecting Africa's healthcare systems owing to the increased healthcare expenditure and negative health outcomes of ADEs. OBJECTIVES We aimed to systematically review published studies on ADEs and synthesize the existing evidence of ADE prevalence in Africa. METHODS Studies reporting on ADE occurrence in African settings and published from Jan 1, 2000 to Oct 1, 2023 were identified by searching PubMed, EBSCO, Science Direct, and Web of Science. Studies that either articulately investigated ADEs caused by clinical condition (such as HIV patients) or ADEs caused by exposure to specific drug(s) (such as antibiotics) were considered specific and the remaining were general. Grouped ADE prevalence rates were described using median and interquartile range (IQR). PROSPERO registration (CRD42022374095). RESULTS We included 78 observational studies from 15 African countries that investigated the prevalence of ADEs leading to hospital admissions (17 studies), developed during hospitalizations (30 studies), and captured in the outpatient departments (38 studies) or communities (4 studies). Twelve studies included multiple settings. The median prevalence of ADE during hospitalization was 7.8% (IQR: 4.2-21.4%) and 74.2% (IQR: 54.1-90.7%) in general and specific patients, respectively. The ADE-related fatality rate was 0.1% and 1.3% in general and specific patients. The overall median prevalence of ADEs leading to hospital admissions was 6.0% (IQR: 1.5-9.0%); in general, patients and the median prevalence of ADEs in the outpatient and community settings were 22.9% (IQR: 14.6-56.1%) and 32.6% (IQR: 26.0-41.3%), respectively, with a median of 43.5% (IQR: 16.3-59.0%) and 12.4% (IQR: 7.1-28.1%) of ADEs being preventable in general and specific patients, respectively. CONCLUSIONS The prevalence of ADEs was significant in both hospital and community settings in Africa. A high ADE prevalence was observed in specific patients, emphasizing important areas for improvement, particularly in at-risk patient groups (e.g., pediatrics, HIV, and TB patients) in various settings. Due to limited studies conducted in the community setting, future research in this setting is encouraged.
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Affiliation(s)
- Linda Nyame
- School of Public Health, Southeast University, Nanjing, China.
| | - Yuhua Hu
- School of Public Health, Southeast University, Nanjing, China
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing, China
| | - Emmanuel D K Fiagbey
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xi Li
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, China.
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Cardoso K, Carroll L. Pulmonary Cryptococcosis: A Diagnostic and Management Challenge Case Report. Cureus 2024; 16:e59361. [PMID: 38817470 PMCID: PMC11138369 DOI: 10.7759/cureus.59361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Cryptococcosis is a fungal infection that may arise in immunocompromised or immunocompetent individuals. This case report seeks to demonstrate the difficulty in diagnosing and treating cryptococcosis based on clinical presentation and radiographic features as together, they mimic other pathological conditions. A 56-year-old female with cirrhosis presented with persistent abdominal pain, dyspnea, vomiting, and diarrhea and was diagnosed with pulmonary cryptococcosis after an initial diagnosis of bacterial pneumonia. With no improvement following antibiotic therapy for suspected bacterial pneumonia, additional imaging was performed with a confirmatory lung biopsy for pulmonary cryptococcosis. The patient initiated antifungal therapy with the anticipation of completing approximately 12 months with follow-up imaging to evaluate improvement. After the patient experienced adverse effects of antifungal therapy and did not achieve significant improvement or recovery in her condition, it was apparent that cryptococcal pneumonia presents both diagnostic and management challenges that must be further explored.
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Affiliation(s)
- Kylee Cardoso
- Infectious Disease, Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, USA
| | - Lisa Carroll
- Family Medicine, Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, USA
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Fimbo A, Mwalwisi YH, Mwamwitwa K, Matiko D, Mfinanga E, Lyimo J, Sabasaba A, Missago S, Bukundi E, Gotora G, Respick D, Nkayamba A, Masunga E, Mnkugwe RH, Kunambi PP, Munishi C, Musanhu CC, Minzi OMS, Mlugu EM. Incidence and determinants of adverse events in individuals with HIV commencing Dolutegravir-based antiretroviral therapy in mainland Tanzania. Sci Rep 2024; 14:615. [PMID: 38182720 PMCID: PMC10770041 DOI: 10.1038/s41598-023-51144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024] Open
Abstract
Tanzania adopted a Dolutegravir (DTG)-based regimen as first-line treatment in 2019 following the World Health Organization recommendation. Data on the DTG safety profile from sub-Saharan Africa including Tanzania are limited. We investigated the incidence of DTG-related adverse events (AEs) and associated factors among people living with HIV (PLHIV) initiated on a DTG regimen. A prospective cohort study was conducted from 25 Care and Treatment Clinics in mainland Tanzania. PLHIV aged 12 years and above who were initiated on a DTG-based regimen were actively followed up for three months. The Cox regression model was used to determine the predictors of occurrence of AEs over time. A p-value of 0.05 was considered statistically significant. From January 2020 to June 2022, a cohort of 935 participants who were both newly diagnosed and ART-experienced who transitioned to a DTG-based regimen was enrolled. Out of 935 participants, 59 (6.3%) reported a total of 62 AEs. The most frequently experienced AE was skin itching and rashes (15/62; 24.2%). DTG-associated neuropsychiatric AEs were less common and included headache (6 [9.6%]) and sleep disturbances (3 [4.8%]). The overall incidence of occurrence of the first AEs was 96.7 per 1000 person-months [95% C.I: 74.4-125.7] with the highest incidence observed among the elderly (≥ 60 years). Individuals on WHO HIV Clinical Stage 2 had a 2.7 significantly higher risk of developing AEs (adjusted hazard ratio = 2.73, 95% CI = 1.46-5.12, p = 0.017). We report a low incidence of grade I (mild) and grade II (moderate) DTG-associated AEs suggesting that the regimen is generally safe in the population. Continued monitoring of DTG safety in the population is recommended.
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Affiliation(s)
- Adam Fimbo
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Yonah H Mwalwisi
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Kissa Mwamwitwa
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Damas Matiko
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Elirehema Mfinanga
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | | | - Amon Sabasaba
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Seth Missago
- National Institute for Medical Research, Headquarters, Dar Es Salaam, Tanzania
| | - Elias Bukundi
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Goodluck Gotora
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Dorice Respick
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Alex Nkayamba
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Emmanuel Masunga
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Rajabu Hussein Mnkugwe
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Peter P Kunambi
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Castory Munishi
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Omary M S Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
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Short-Term Adverse Drug Reactions to Antiretroviral Therapy in Children with HIV: A Cohort Study. Indian J Pediatr 2023; 90:9-15. [PMID: 35113365 DOI: 10.1007/s12098-021-04045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/18/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To carry out an active surveillance for adverse drug reactions (ADRs) in children with HIV infection newly initiated on antiretroviral therapy (ART), determine risk factors for their occurrence, and assess their influence on adherence to ART. METHODS All children newly initiated on ART from 1st March 2014 to 30th June 2019 at a tertiary care children's hospital in New Delhi, were actively monitored for ADRs to ART for a period of 6 mo after ART initiation. The frequency, spectrum, and severity of ADRs, their influence on adherence, and risk factors for their occurrence were analyzed. RESULTS Among the 174 enrolled children, ADRs were observed in 78 (44.8%) children during the first 6 mo after ART initiation. Total numbers of episodes of ADR observed were 108 (0.62 episodes of ADR/child). Sixty percent of events were of grade 1 severity, 19.4% events were of grade 2 and 3 each, while 1 (0.9%) event was of grade 4 severity. Adherence to ART was adversely affected in 21.8% of ADRs. Gastrointestinal symptoms (49.1%) were most frequent among all the events observed. Zidovudine, lopinavir/ritonavir, efavirenz and nevirapine based regimes were significantly associated with hematological, gastrointestinal, neurological, and dermatological ADRs, respectively. Children with immunological suppression were at a higher risk of developing ADRs as compared to those without it [RR 1.9 (95% CI (1.1-3.2)]. CONCLUSIONS ADRs to ART are very frequent; most of them are mild and self-limiting. However, they can adversely impact adherence to ART. Anticipatory guidance, ongoing monitoring, and provision of symptomatic treatment will help tide over most ADRs and reduce their adverse impact upon ART adherence.
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Adverse Drug Reactions to Antiretroviral Therapy in Federal Medical Centre, Makurdi, Nigeria. JOURNAL OF RESEARCH IN APPLIED AND BASIC MEDICAL SCIENCES 2022. [DOI: 10.52547/rabms.8.4.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Weldesenbet AB, Tusa BS, Debele GR, Sisay MM, Ayele TA. Time to First Line Antiretroviral Therapy Adverse Drug Reaction and its Predictors Among Adult HIV/AIDS Patients on Treatment in Eastern Ethiopia. Front Pharmacol 2022; 13:922744. [PMID: 36046817 PMCID: PMC9421417 DOI: 10.3389/fphar.2022.922744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Even though determining the time to anti-retroviral therapy (ART) adverse drug reaction and its predictors is a crucial step to overcome the negative consequences of the adverse drug reaction, there is limited information regarding the time to ART adverse drug reaction and its predictors. Therefore, this study aimed to determine the time to first ART adverse drug reaction and its predictors among adult HIV/AIDS patients on first-line antiretroviral therapy in West Hararghe Zone, Eastern Ethiopia. Methods: An institution-based retrospective cohort study was conducted on 561 HIV/AIDS patients on first-line ART from September 2013–January 2019 at public hospitals in West Hararghe Zone, Eastern Ethiopia. Data were collected using checklists and document reviews, entered using Epi Info and analyzed in R software. A Cox proportional hazard model was fitted to identify predictors of the time to first ART adverse drug reaction. Model adequacy was checked using Cox Snell residuals. An adjusted hazard ratio with its confidence interval was used to show the presence and strength of association at a 95% confidence level. Result: Most (90.74%) ART adverse drug reactions occurred within 1 year of initiation of ART. Overall, 54 patients developed ART adverse drug reactions with an incidence density of 3.5/100 persons-years of observations (95% CI: 2.7–4.6). The initial ART regimen (TDF, 3TC, EFV) [AHR = 0.3, 95% CI 0.1–0.7], fair adherence [AHR = 8.8, 95% CI 3.3–23.2], poor adherence [AHR = 7.8, 95% CI 3.1–19.5], moderate body mass index (BMI) at the baseline [AHR = 4.4, 95% CI 1.8–11.0], severe body mass index [AHR = 2.8, 95% CI 1.1–6.8], World Health Organization (WHO) stage II [AHR = 3.7, 95% CI 1.2–11.3] and WHO stage IV [AHR = 6.3, 95% CI 2.0–19.8] were significant predictors of the time to ART adverse drug reactions. Conclusion: In conclusion, most of the ART adverse drug reactions occurred within 1 year of initiation of ART. The initial ART regimen (TDF, 3TC, EFV), adherence, HIV/AIDS stage, and BMI were risk factors for the time to ART adverse drug reaction. The incidence of the antiretroviral therapy adverse reaction was relatively low with early onset. Close monitoring of clients in clinical stage II and above is required and continuous assessment for improving the detection and management of adverse drug reactions is recommended. Patients with poor adherence need to get continuous counseling to improve their adherence status.
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Affiliation(s)
- Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- *Correspondence: Biruk Shalmeno Tusa,
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tarranza JLS, Ang MCD. The association of CD4 lymphocyte count with drug hypersensitivity reaction to highly active antiretroviral therapy, trimethoprim sulfamethoxazole, and antitubercular agents in human immunodeficiency virus patients. Asia Pac Allergy 2022; 12:e26. [PMID: 35966163 PMCID: PMC9353209 DOI: 10.5415/apallergy.2022.12.e26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background The introduction of highly active antiretroviral therapy (HAART) and antibiotic regimens for the treatment of human immunodeficiency virus (HIV) and its concomitant opportunistic infections, respectively, significantly improve the morbidity and mortality of the infected patients. However, these drugs commonly cause drug hypersensitivity reactions (DHRs) in patients with acquired immunodeficiency syndrome. The reason proposed are multifactorial, which includes immune hyperactivation, changes in drug metabolism, patient cytokine profiles, oxidative stress, genetic predisposition, and the principal target in HIV patients, the CD4+ lymphocytes. Objective This study determined the association of CD4 count and DHRs to first-line HAART, trimethoprim sulfamethoxazole, and antitubercular agents among HIV patients. Methods This is a retrospective analytical study. Review of charts were done. The demographic and clinical profile used a descriptive statistics such as mean and standard deviation for quantitative data and frequency and percent for categorical data. Chi-square and Fisher exact tests were used to measure the degree of the relationship of CD4 count and DHRs. Results A total of 337 eligible patients were included. There was a 25% incidence of hypersensitivity reactions. However, the prevalence of DHRs across the different CD4 groups was not statistically significant (p = 0.167). Likewise, the study found no significant association between the CD4 count and DHRs to first-line HAART, trimethoprim sulfamethoxazole, and antitubercular agents (p = 0.311). The most common DHR was morbilliform rash, and nevirapine was the most reported antiretroviral drug causing DHR. Conclusion There was no association in the CD4 count and DHRs to first-line HAART, trimethoprim sulfamethoxazole, and antitubercular agents. Hence, regardless of the baseline CD4 lymphocyte count, the physician should be vigilant in monitoring hypersensitivity reactions. Patient education on common DHRs is very important upon diagnosis of HIV and/or initiation of treatment.
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Affiliation(s)
- Jannah Lee S. Tarranza
- Department of Internal Medicine, Southern Philippines Medical Center, Davao City, the Philippines
| | - Maria Carmen D. Ang
- Allergy and Immunology, Department of Internal Medicine, Southern Philippines Medical Center, Davao City, the Philippines
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Abah IO, Dayom WD, Dangiwa DA, Aderemi-Williams R, Anejo-Okopi J, Agbaji OO, Kanki P, Aguiyi JC. Comparative incidence of adverse drug reaction during the first and subsequent year of antiretroviral therapy in a Nigerian HIV infected Cohort. Afr Health Sci 2021; 21:1027-1039. [PMID: 35222564 PMCID: PMC8843256 DOI: 10.4314/ahs.v21i3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse. Objectives To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART. Method We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-positive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared. Results of the 13,983 patients' data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years. Conclusion The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs.
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Affiliation(s)
- Isaac O Abah
- Department of Clinical Pharmacy and Pharmacy Practice, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Wetkos D Dayom
- Department of Clinical Pharmacy and Pharmacy Practice, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Dauda A Dangiwa
- Department of Clinical Pharmacy and Pharmacy Practice, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Roseline Aderemi-Williams
- Department of Clinical Pharmacy & Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba Campus, Lagos, Nigeria
| | | | - Oche O Agbaji
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis Kanki
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - John C Aguiyi
- African Centre of Excellence for Phytomedicine Research and Development University of Jos, Jos, Nigeria
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Chikeya G, Oosthuizen F, Bangalee V. Annual Costs Incurred in Managing Adverse Drug Reactions Attributable to Fixed-Dose Combination Highly Active Antiretroviral Therapy in an Outpatient Antiretroviral Clinic in Gauteng: A Budget Impact Analysis. Value Health Reg Issues 2021; 25:142-149. [PMID: 34130039 DOI: 10.1016/j.vhri.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/22/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to identify adverse drug reactions (ADRs) attributable to tenofovir (TDF)- and zidovudine (AZT)-based fixed-dose combinations of highly active antiretroviral (ARV) therapy and subsequently determine the annual costs incurred in managing these ADRs and the budget implications in an outpatient ARV clinic in Mamelodi, Pretoria. METHODS This retrospective cohort study reviewed deidentified clinical data for ADRs. Medical charts of human immunodeficiency virus-positive patients, who were receiving either TDF- or AZT-based fixed-dose combinations of ARV therapy, were analyzed. Costs were converted to US dollars using the rate of US$1 equivalent to ZAR14.3853. Based on the costs and the incidence rates of ADRs observed in the analysis, a decision tree model was established to estimate the cost impact of ADR management on the clinic's budget. RESULTS A total of 469 patient files were analyzed (62% female vs 38% male). The mean age at the start of ARV therapy for the cohort was 36.6 years (95% confidence interval 35.74-37.45), and the mean baseline CD4 count was 380 (95% confidence interval 343-418). The incidence of ADRs to TDF- or AZT-based fixed-dose combinations of ARV therapy was found to be 24.95%. The study revealed that US$29.70 was the cost attributed to ADRs owing to TDF-based regimens, whereas US$32.53 was the cost attributed to ADRs owing to AZT-based regimens, per patient, annually. Costs attributed to gastrointestinal-related ADRs were the highest in comparison with other ADRs. The estimated total cost of ADRs attributed to AZT-based therapy was US$556.40, and the estimated total cost of ADRs attributed to TDF-based ARV therapy per annum was US$2348.80 for the 1221 patients who started receiving ARV therapy between July 2017 and June 2018 at the clinic. CONCLUSIONS Despite the estimated costs related to ADRs in the study being lower than those in similar studies, there remains a notable budget impact, particularly in a resource-limited setting. The study findings allow for improved budget forecasts in an ARV clinic setting.
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Affiliation(s)
- Grace Chikeya
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Frasia Oosthuizen
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Gebremeskel TG, Gebreyowhans D, Abrha Gesesew H, Ward PR. Incidence and Predictors of Severe Adverse Drug Reaction Among Patients on Antiretroviral Therapy in Tigray, Ethiopia: A Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:641-649. [PMID: 34135642 PMCID: PMC8200146 DOI: 10.2147/hiv.s310419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Background The aim of the present study was to assess the incidence and predictors of severe adverse drug reactions among patients on antiretroviral therapy (ART) in Tigray, North Ethiopia. Methods We employed four years retrospective cohort study using a structured data extraction sheet. The study populations were HIV patients on ART follow-up from January 2017 to February 2020 in the study area. Severe adverse drug reaction (ADR) was an outcome variable and defined as having any one of the complaints related to ARV drug reaction due to regimen change, discontinuation, and/or in-patient care. Data were collected using a structured data extraction sheet. A Cox proportional hazard regression model was used to determine the relationship between the predictors and the outcome variable. The mean survival time of the cohort was estimated using the Kaplan-Meier method. Results The incidence rate of ADRs was 3.6 (95%CI: 2.9-4.35) per 100-person years. HIV patients with no formal education (adjusted hazard ratio=1.58, 95%CI: 1.03-2.41), with experience of regimen change (adjusted hazard ratio=1.59, 95%CI: 1.12-2.91), who ever took other medication (adjusted hazard ratio=1.49, 95%CI: 1.05-2.15) and with lower body mass index (adjusted hazard ratio=3.24, 95%CI: 1.18-4.91) were more likely to develop severe adverse drug reaction. Conclusion ADRs were diagnosed an inconsiderable number of HIV patients on ART and factors were patient and drug-related. To minimize it, special attention is sought for patients with no formal education, previous regime change, whoever took other medication, and who have lower body mass index levels.
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Affiliation(s)
- Teferi Gebru Gebremeskel
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Destalem Gebreyowhans
- School of Medicine, College of Medicine and Health Science, Aksum University, Aksum, Ethiopia
| | - Hailay Abrha Gesesew
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Epidemiology, College of Health Sciences, Mekele University, Mekele, Ethiopia
| | - Paul R Ward
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
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Incidence and predictors of Adverse Drug Reaction (ADR) among adult HIV positive patients on anti-retroviral treatment in Arba Minch town public health facilities, southern Ethiopia: A retrospective cohort study, 2020. PLoS One 2021; 16:e0251763. [PMID: 34043687 PMCID: PMC8158905 DOI: 10.1371/journal.pone.0251763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background Besides its contribution in the treatment of Human Immunodeficiency Virus-infected patients, anti-retroviral drugs may also cause mild to serious adverse effects. It is the main causes for poor drug adherence, treatment discontinuation and changes in Anti-Retroviral Treatment (ART) regimens. Thus, the aim of this study was to assess the incidence and predictors of adverse drug reaction among adult Human Immunodeficiency Virus positive patients on anti-retroviral treatment from January 1, 2013 up to December 30, 2018 at Arba Minch town public health facilities, Southern Ethiopia. Methods An institution based retrospective cohort study was conducted on 456 charts. Secondary data was collected by structured questionnaire. Data were entered in Epi-data version 4.4.2 software and exported to STATA Version 14 for analysis. The Kaplan-Meier survival curve with Log-rank was used to estimate survival time. Bi-variable and multivariable Cox proportional hazard regression models were fitted to identify predictors of adverse drug reaction. In the bi-variable analysis, the variables with p-value < 0.25 were eligible for multivariable analysis. Finally, variables with p-values less than 0.05 in the multivariable Cox regression were considered as independent predictors. The statistical significance was declared at p-value<0.05. Results Out of 456 patients observed for 14,903 person-months (pm), 79 experienced adverse drug reactions and the overall incidence density rate was 0.53/100 pm, CI: 0.42–0.66/100 person’s month or 6.36 per 100 Pearson year of observation. Females were at higher risk of experiencing adverse drug reactions (ADRs) compared to males [AHR = 2.35; CI (1.18, 4.69)]. The risk of experiencing ADRs among patient with advanced WHO clinical stage (stage III and IV) was higher compared to stage I and II [AHR = 3.0, CI (1.22, 7.37)]. The risk of experiencing an ADR was at any given time higher among AZT and NVP containing regimens compared to TDF and EFV containing regimens. Finally, the risk of ADR among those patients from the health center was reduced by 59% compared to hospital patients, [AHR = 0.41, CI (0.17, 0.97)]. Conclusion and recommendation The incidence rate of ADRs was reduced among patients on ARVs compared to previous studies and it was high during the early years of ART initiation. HIV patients should be closely followed in the early years of ART initiation, since this is the time of highest risk ADRs and emphasis should be given for female and clinically advanced patients.
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Mitkie AA, Bekele FB, Debiso AT. Predictors of adverse drug reaction among adult HIV-infected patients on antiretroviral therapy in government hospitals of Kaffa Zone, Ethiopia; November 2018: a retrospective cohort. Pan Afr Med J 2021; 38:181. [PMID: 33995787 PMCID: PMC8106778 DOI: 10.11604/pamj.2021.38.181.19915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/13/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction incidence of adverse drug reactions (ADR) associated with antiretroviral therapy (ART) was higher in developing countries. In two teaching hospital in Ethiopia: Debremarkose 23% and Yirgalem 73.2% of study participants reported at least one ADR. Since there was limited information about ADR in the study area; we aimed to determine its incidence-rate and predictors. Methods we conducted retrospective cohort study using medical records of HIV-infected patients enrolled on ART between 2006 and 2017 in government hospitals of Ethiopia. ADR was defined as report of at least one unwanted response to ART. We run descriptive and cox regression analysis (CRA). Results incidence-rate of ADR was 4.1 per 100 person-years (py). Hazards of ADR among patients living at rural was almost two times than at urban; [Adjusted hazard ratio (AHR): 1.94(95% (CI): 1.18, 3.20)]. Stavudine (D4T)-Lamivudine (3TC)-Nevirapine (NVP) had about two times [AHR: 1.78(95%CI: 1.03, 3.08)], Zidovudine(AZT)-3TC-NVP had about two times [AHR: 2.34 (95%CI: 1.20, 4.57)], D4T-3TC-Efaviranze(EFV) had about three times [AHR: 2.86(95%CI: 1.38, 5.95)] and AZT-3TC-EFV had about two times [AHR: 2.16(95%CI: 1.21,3.90)] hazards of ADR than Tenofovir(TDF) based regimens. Being WHO clinical stage III had about two times hazard of ADR [AHR: 2.46 (95%CI: 1.22, 4.95)] and IV had about four times hazard of ADR [AHR: 4.32 (95%CI: 1.88, 9.93)] than stage I. Conclusion risk of ADR was higher among adult HIV-infected patients on ART living in rural, WHO clinical stage III and IV, and patients on AZT and D4T based regimen. AZT should not be given as an alternative treatment, increase access of TDF regimens.
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Affiliation(s)
| | - Fanuel Belayneh Bekele
- School of Public Health, College of Medicine and Health, Hawassa University, Hawassa, Ethiopia
| | - Alemu Tamiso Debiso
- School of Public Health, College of Medicine and Health, Hawassa University, Hawassa, Ethiopia
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Muche EA, Kiflu M, Ayalew MB. Patient Reported Central Nervous System Adverse Events of Efavirenz-Based Antiretroviral Therapy in People Living with HIV in Northwest Ethiopia. HIV AIDS (Auckl) 2020; 12:601-609. [PMID: 33116922 PMCID: PMC7585818 DOI: 10.2147/hiv.s276111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Central nervous system (CNS) toxicities from regimens containing efavirenz are the main reasons for non-adherence, switch and discontinuation of antiretroviral therapy (ART). We aimed to assess prevalence of CNS adverse events and associated factors among HIV patients taking efavirenz-based regimens at the University of Gondar Comprehensive and Specialized Hospital (UoGCSH), Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted from March 15 to May 15, 2018 on 345 patients living with HIV who were taking efavirenz-based regimens. Information on sociodemographic and clinical characteristics was taken from medical records and patient interview. Binary logistic regression analysis was done to determine association. Statistical significance was declared at P value of ≤ 0.05. Results About 52.8% of participants experienced CNS adverse events. Vivid dreams, confusion, insomnia and somnolence were the most frequently reported adverse events. Most of the CNS adverse events occurred in the first year of treatment initiation and resolved within 1–4 weeks. Age, economic status, CD4 count, disease stage, presence of comorbidities and concurrent use of other medication had a significant association with the occurrence of CNS adverse events. Conclusion More than half of HIV patients taking efavirenz-based regimens at UoGCSH experienced CNS adverse events. Health-care providers should give attention to patients on efavirenz therapy to monitor for CNS adverse events, especially for patients who have low CD4 count, advanced disease, comorbidities, low income and are older in age.
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Affiliation(s)
- Esileman Abdela Muche
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekdes Kiflu
- Department of Pharmacy, College of Medicine and Health Sciences, Debremarkose University, Debremarkos, Ethiopia
| | - Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rukmangathen R, Brahmanapalli VD, Thammisetty DP, Pemmasani D, Gali SD, Atmakuru RB. Study of adverse drug reactions to antiretroviral therapy in a tertiary care hospital, Tirupati. Perspect Clin Res 2020; 11:158-163. [PMID: 33489833 PMCID: PMC7819369 DOI: 10.4103/picr.picr_133_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/25/2018] [Accepted: 03/12/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: Human immunodeficiency virus-infected patients do not adhere to their antiretroviral therapy (ART) due to adverse effects of drugs. The continuous monitoring of adverse drug reactions (ADRs) may ensure the safe use of drugs in patients. Hence, a retrospective analysis was carried out to assess the ADRs pattern, causality, and severity associated with various antiretroviral drug regimens in patients receiving ART. Materials and Methods: A retrospective, analytical study was carried out at ART nodal center in Sri Venkateswara Ramnarain Ruia Government General Hospital, Tirupati. Data were collected by spontaneous reporting of health-care professionals from ART centers using Suspected ADR Reporting Forms of Indian Pharmacopoeia Commission to record the ADRs occurred in the patients who underwent treatment from December 2015 to November 2016. A total of 299 ADR reports were collected during the study period. The causality and severity of the reported ADRs were assessed using suitable scales. Results: From a total of 299 ADR reports, females (63.81%) experienced higher ADRs than males (36.12%). The highest number of ADRs was reported to zidovudine/lamivudine/nevirapine (ZLN) regimen (76.92%) than tenofovir/lamivudine/efavirenz (TLE) regimen (23.07%). Cutaneous reactions were higher (34.34%) among patients receiving ZLN therapy, and drowsiness (53.62%) was the most common ADR in patients receiving TLE regimen. According to the World Health Organization causality assessment scale, most of the ADRs were possible (75.92%). On the assessment of Modified Hartwig and Siegel Severity Scale, 55.09% of ADRs were moderate. Conclusion: The study showed an increased incidence of ADRs to ART which calls for efficient pharmacovigilance systems to improve patient care and drug safety.
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Affiliation(s)
| | | | - Durga Prasad Thammisetty
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
| | - Deepishka Pemmasani
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
| | - Sai Deepak Gali
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
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Agegnehu CD, Merid MW, Yenit MK. Incidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study. BMC Infect Dis 2020; 20:460. [PMID: 32611405 PMCID: PMC7329399 DOI: 10.1186/s12879-020-05177-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Although the United Nations program on HIV/AIDS 90–90-90-targets recommends achieving 90% of viral suppression for patients on first-line antiretroviral therapy by 2020, virological failure is still high and it remains a global public health problem. Therefore, assessing the incidence and predictors of virological failure among adult HIV patients on first-line ART in Amhara regional referral hospitals, Ethiopia is vital to design appropriate prevention strategies for treatment failure and preventing the unnecessary switching to second-line regimens. Method An institution-based retrospective follow-up study was conducted on 490 adult HIV patients. The simple random sampling technique was used, and data were entered into Epi data Version 4.2.0.0 and was exported to Stata version 14 for analysis. The proportional hazard assumption was checked, and the Weibull regression was fitted. Cox-Snell residual was used to test the goodness of fit, and the appropriate model was selected by AIC/BIC. Finally, an adjusted hazard ratio with a 95% CI was computed, and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors of virological failure. Results The overall incidence rate of virological failure was 4.9 events per 1000 person-month observations (95%CI: 3.86–6.38). Users of CPT (AHR = 0.55, 95%CI: 0.31–0.97), poor adherence (AHR = 5.46, 95%CI: 3.07–9.74), CD4 Count <=200 cells/mm3 (AHR = 3.9, 95%CI: 1.07–13.9) and 201–350 cells/mm3 (AHR 4.1, 95%CI: 1.12–15) respectively, and NVP based first line drug regimen (AHR = 3.53, 95%CI: 1.73–7.21) were significantly associated with virological failure. Conclusion The incidence rate of virological failure was high. CPT, poor adherence, low baseline CD4 count and NVP based first-line drug regimen were independent risk factors associated with virological failure. Therefore, strengthening HIV care intervention and addressing these significant predictors is highly recommended in the study setting.
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Affiliation(s)
- Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shen Y, Liu T, Chen J, Li X, Liu L, Shen J, Wang J, Zhang R, Sun M, Wang Z, Song W, Qi T, Tang Y, Meng X, Zhang L, Ho D, Ho C, Ding X, Lu H. Harnessing Artificial Intelligence to Optimize Long‐Term Maintenance Dosing for Antiretroviral‐Naive Adults with HIV‐1 Infection. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yinzhong Shen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Tingyi Liu
- Department of Mechanical and Industrial EngineeringUniversity of Massachusetts Amherst MA 01003 USA
- Department of Mechanical and Industrial EngineeringInstitute for Applied Life Sciences (IALS)University of Massachusetts Amherst Amherst MA 01003 USA
| | - Jun Chen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Xin Li
- Institute for Personalized MedicineState Key Laboratory of Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong University Shanghai 200030 China
| | - Li Liu
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Jiayin Shen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Jiangrong Wang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Renfang Zhang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Meiyan Sun
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Zhenyan Wang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Wei Song
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Tangkai Qi
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Yang Tang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Xianmin Meng
- Department of PharmacyShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Lijun Zhang
- Department of Scientific ResearchShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Dean Ho
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
- Department of Biomedical Engineering, NUS EngineeringNational University of Singapore Singapore 117583
- Department of PharmacologyYong Loo Lin School of MedicineNational University of Singapore Singapore 117600
| | - Chih‐Ming Ho
- Mechanical and Aerospace Engineering DepartmentBioengineering DepartmentUniversity of California California LA 90095 USA
| | - Xianting Ding
- Institute for Personalized MedicineState Key Laboratory of Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong University Shanghai 200030 China
| | - Hong‐Zhou Lu
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
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Badillo CA, Barrera LK, Arias G, Tribiño GF, Gamboa OA, García JC, Granada AM. Incidence of antiretroviral drug-related problems in the treatment of HIV among hospitalized patients in the Hospital Santa Clara, Bogotá. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:561-575. [PMID: 31584769 PMCID: PMC7357364 DOI: 10.7705/biomedica.4345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 03/13/2019] [Indexed: 11/21/2022]
Abstract
Introduction: The antiretroviral therapy for the treatment of the human immunodeficiency virus (HIV) is a therapeutic strategy linked to drug-related problems that cause or can cause the appearance of negative results associated with the medication. It is important, therefore, to identify their incidence, characterize them, and classify them to design strategies to minimize their impact. Objective: To estimate the overall incidence and the incidence of each one of the antiretroviral drugs-related problems in the treatment of the HIV infection in a cohort of hospitalized patients in Bogotá, Colombia. Materials and methods: We conducted a descriptive, retrospective cohort study in patients aged 18 years or more diagnosed with HIV infection and under antiretroviral treatment hospitalized between January 1st, 2015, and December 31st, 2016, in the Hospital Santa Clara, Bogotá. Results: The overall incidence of antiretroviral drug-related problems was 0.90 (95% CI: 0.85-0.93). The incidence of drug-drug interactions was 0.85 (95% CI: 0.80-0.90), 0.28 (95% CI: 0.22-0.35) for adverse reactions, and 0.12 (CI 95%: 0.08-0.17) for prescription errors. Conclusion: Drug-related problems should be studied, diagnosed, prevented, and treated. Their knowledge can enable health care professionals to anticipate their emergence, reduce their incidence, implement risk management plans, and optimize adherence to antiretroviral treatment.
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Affiliation(s)
- Carlos Andrés Badillo
- Grupo de Investigación en Evidencia Terapéutica, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia.
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Nartey ET, Tetteh RA, Yankey BA, Mantel-Teeuwisse AK, Leufkens HGM, Dodoo ANO, Lartey M. Tenofovir-associated renal toxicity in a cohort of HIV infected patients in Ghana. BMC Res Notes 2019; 12:445. [PMID: 31331365 PMCID: PMC6647254 DOI: 10.1186/s13104-019-4454-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treatment guidelines. Purpose of this study was to estimate the long term effects of TDF on renal profile in a cohort of HIV patients in Ghana. Three hundred (300) consecutive HIV-positive patients who initiated TDF-based antiretroviral treatment in 2008 at the Korle-Bu Teaching Hospital were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was defined as CrCl values of 30.0–49.9 mL/min (moderate renal impairment) and < 30 mL/min (severe renal impairment) as per institutional guidelines for renal function test. Results Median follow up time was 2.9 years (IQR 2.3–3.4 years). At study endpoint, 63 participants (21.0% [95% CI 6.5–26.1]) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 18.3% moderate renal impairment and 2.3% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, WHO HIV stage III/IV and participants with BMI of < 18.5 kg/m2. Patients with identified renal impairment risk factors at ART initiation should be targeted and monitored effectively to prevent renal injury.
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Affiliation(s)
- Edmund T Nartey
- Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana School of Medicine and Dentistry, P. O. Box GP 4236, Accra, Ghana.
| | - Raymond A Tetteh
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.,Pharmacy Department, Korle-Bu Teaching Hospital, P.O. Box KB 77, Korle-Bu, Accra, Ghana
| | | | - Aukje K Mantel-Teeuwisse
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Alexander N O Dodoo
- Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana School of Medicine and Dentistry, P. O. Box GP 4236, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana School of Medicine and Dentistry, P. O. Box GP 4236, Accra, Ghana
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Oumar AA, Dakouo M, Tchibozo A, Maiga M, Landouré G, Abdi-Bogoreh R, Tulkens PM, Dao S, Yombi JC. Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience. ACTA ACUST UNITED AC 2019; 8:831-836. [PMID: 31879663 PMCID: PMC6931397 DOI: 10.18203/2319-2003.ijbcp20191565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population. Methods This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo's classification scale. Results During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others. Conclusions Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.
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Affiliation(s)
| | - Mamadou Dakouo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Anicet Tchibozo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Mamoudou Maiga
- Department of Global Health, Northwestern University, Chicago, USA
| | - Guida Landouré
- Department of Neurology, Centre Hospital, University du Point «G», Bamako, Mali
| | | | - Paul M Tulkens
- Department of Cellular & Molecular Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Sounkalo Dao
- Department of Infectious Diseases, Centre Hospital, University du Point «G», Bamako
| | - Jean Cyr Yombi
- Department of Internal Medicine & Infectious Diseases, AIDS Reference Center, Catholic University of Louvain, Brussels, Belgium
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Awodele O, Aliu R, Ali I, Oni Y, Adeyeye CM. Patterns of adverse drug reaction signals in NAFDAC pharmacovigilance activities from January to June 2015: safety of drug use in Nigeria. Pharmacol Res Perspect 2019; 6:e00427. [PMID: 30324768 PMCID: PMC6175912 DOI: 10.1002/prp2.427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/20/2022] Open
Abstract
Adverse drug reactions (ADRs) are expected to be associated with an economic drain on the healthcare systems. The study was carried out to determine the occurrence of ADRs reported to NAFDAC Pharmacovigilance from January to June 2015, to illustrate the pattern of organ system affected by ADRs, to assess the completeness of ADR report, to determine the relationship between the occurrence of ADRs with suspect drugs and the use of concomitant drugs as well as to generate possible signals from the reported ADRs. A total number of 921 ADR cases reported from January to June 2015 were analyzed using SPSS version 22. A higher percentage of ADR reports were seen in females (65.5%). The highest percentages of reports (45.6%) were from the age range of 21‐40 years, most of the suspected drugs reported had both NAFDAC (50.2%) and batch number identification (65.6%). HIV (56.9%) was the most prevalent indication reported for using the suspected drug; Zidovudine/Lamivudine/Nevirapine combination (16.9%) was reported as the suspected drug with the highest occurrences of ADRs and generalized body itching (6.9%) as the most prevalent ADR. “General disorders” (47.3%) was the most predominant organ system affected by ADRs and Pharmacists were revealed as the highest reporters of ADRs (80.2%). Overall, patients on ARVs should be vigilantly followed up as they are mostly prone to ADRs. Adverse drug reaction reporting systems need to be robust and complete in order to be able to detect new drug alerts, possible signals and improve pharmacovigilance
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Affiliation(s)
- Olufunsho Awodele
- Department of Pharmacology, Therapeutics & Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Aliu
- Department of Pharmacology, Therapeutics & Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ibrahim Ali
- National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, Nigeria
| | - Yetunde Oni
- National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, Nigeria
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Ikunaiye N, Denue B, Aina B, Aderemi-Williams R, Rawizza H. INCIDENCE OF ANAEMIA AMONG HIV-INFECTED PATIENTS TREATED WITH ZIDOVUDINE-CONTAINING ANTIRETROVIRAL THERAPY IN NORTHEASTERN NIGERIA. Ann Ib Postgrad Med 2018; 16:115-124. [PMID: 31217768 PMCID: PMC6580400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Zidovudine (AZT) is a common component of antiretroviral therapy (ART) in resource-limited settings. However, AZT is associated with myelotoxity that often presents with anaemia. The aim of this study was to determine the incidence of anaemia among patients initiated on AZT-containing and non-AZT containing ART regimens. METHODS In this retrospective analysis, records from 800 ART-naïve HIV-infected patients were abstracted by simple random sampling from program databases. Rates of anaemia were compared between patients initiated on AZT- versus non- AZT-containing ART regimens. Patients were stratified according to absence (Group A) or presence (Group B) of baseline anaemia defined as haemoglobin < 10.5g/dl. Incidence was calculated as total cases of AZT-induced anaemia (group A) or worsening of anaemia (group B) during the study period divided by person-time at risk and adjusted per 100 person-years. Average time-to-event and survival curve were estimated using Kaplan Meier survival analysis. RESULTS In group A (without baseline anaemia), the incidence of anaemia in the AZT-exposed versus non-exposed cohorts was 73.3 and 17.6 per 100 patient years at 6 months, and 60.5 and 8.5 per 100 patient years at 12 months, respectively. In group B, the incidence of worsening anaemia was 65.9 and 26.2 per 100 patient years at 6 months, and 57.5 and 17.9 per 100 patient years after 12 months in AZT-exposed and AZT-unexposed cohorts, respectively. The estimated time to event (developing anaemia) was 2.3 (1.5 - 3.4) months, while estimated to event (worseninig anaemia) was 2.0 (1.5 - 4.0). CONCLUSION HIV-infected patients initiated on AZT-containing ART are 2.7 and 4.5 more likely to develop anaemia at 6 and 12 months, respectively, compared to those initiating a non-AZT containing regimen. When censored at 12 months the overall incidence of AZT-related anaemia was estimated at 22.3% (38.2 incidences per person years). Majority (75%) of the AZT-related anaemia occurred early with estimated time-to-event occurring within the first 3.8 months.
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Affiliation(s)
- N.Y. Ikunaiye
- Department of Pharmacy, University of Maiduguri Teaching Hospital, Borno State
| | - B.A. Denue
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Borno State
| | - B.A. Aina
- Department of Clinical Pharmacy, University of Lagos, Lagos State
| | | | - H.E. Rawizza
- Harvard TH Chan School of Public Health, Boston MA, USA
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Kefale AT, Dadi TL, Biru TT, Mega TA. Treatment Outcome and Adverse Events of Tenofovir Disoproxil Fumarate Based Regimens as Compared to Zidovudine Based Regimens Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis of Observational Studies. Open AIDS J 2018; 12:38-52. [PMID: 30008973 PMCID: PMC6009132 DOI: 10.2174/1874613601812010038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Findings from different studies report inferior clinical and virologic efficacy with TDF/3TC/NVP. But, some studies show that, there was no statistically significant difference in mortality among ZDV and TDF based regimens. The objective of this review was to systematically identify, appraise and synthesize the best available evidence on efficacy and safety of TDF based regimen as compared to ZDV based regimens. Methods: A three-step search strategy was used to locate published and unpublished studies. First, an initial limited search of google was undertaken followed by analysis of text words. A second extensive search was undertaken. We searched the PubMed, EMBASE, Google Scholar, Medline, and CINHAL. We did the initial search for articles on July 11-18, 2016, and updated the results on May 13, 2017.Third, the reference lists of all identified articles was searched for additional studies. Results: ZDV based regimens had better outcome on prevention of mortality (OR=1.31, 95%CI (1.14, 1.50), I2 = 0%, Chi2 = 2.51), and lower virologic failure (OR = 1.44, 95% CI [1.18, 1.76], chi2 = 5.91, P= 0.003, I2 =83%) while, TDF based regimens were more tolerable (OR=0.15, 95%CI (0.08, 0.30), I2 = 40%, Chi2 = 3.31). The difference in incidence of opportunistic infection is not significant (OR = 0.83, 95% CI [0.52, 1.32], chi2 = 0.11, P= 0.42, I2 =0%). Conclusion: There is lower mortality and lower virologic failure in ZDV group, but better safety profile among TDF based regimens.
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Mendes JC, Bonolo PDF, Ceccato MDGB, Costa JDO, Reis AMM, Dos Santos H, Silveira MR. Adverse reactions associated with first-line regimens in patient initiating antiretroviral therapy. Eur J Clin Pharmacol 2018; 74:1077-1088. [PMID: 29740676 DOI: 10.1007/s00228-018-2472-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/25/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence of adverse drug reactions (ADR) and associated factors during the use of Highly Active Antiretroviral Therapy (HAART) in patients initiating treatment. METHODS This is a cross-sectional analysis of a prospective study conducted in three public referral services specialized in HIV/AIDS care in Belo Horizonte, Brazil. Self-reported ADR and explanatory variables were obtained from face-to-face interview and from Information Systems. Associated factors with ADR were evaluated by logistic regression in SPSS software v.22. RESULTS We included 399 patients, of which 85.5% reported at least one and 72.7% up to 5 ADRs after HAART initiation. Neurological reactions were the most frequent, with self-reported ADRs being distinct according to HAART regimen used. The global model showed higher chance of ADRs among females (OR = 3.52) and illicit drug users (OR = 2.28). Lower chance of ADRs was found for patients aged > 33 years (OR = 0.37), DTG/TDF/3TC users (OR = 0.41), and higher physical domain of quality of life (OR = 0.78). The model restricted to patients using the single-tablet regimen EFV/TDF/3TC showed lower ADRs among patients with CD4+ T lymphocyte count > 200 cells/mm3 (OR = 0.23) and higher independence domain of quality of life (OR = 0.74). The model restricted to DTG/TDF/3TC and to other regimens showed lower ADRs with higher physical domain of quality of life (OR = 0.74 and OR = 0.55, respectively). CONCLUSIONS The prevalence of self-reported ADRs to first-line antiretroviral regimens was high and patients using DTG/TDF/3TC had a smaller number of ADRs. In addition to HAART regimen, sociodemographic, clinical, and quality of life characteristics were associated with ADRs.
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Affiliation(s)
- Jullye Campos Mendes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Palmira de Fátima Bonolo
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana de Oliveira Costa
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Henrique Dos Santos
- Instituto de Educação Continuada, Pontifícia Universidade Católica de Minas Gerais-PUC Minas, Rua Cláudio Manoel 1205, Funcionários, Belo Horizonte, Minas Gerais, 30140-100, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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Ahmed SI, Farooqui M, Syed Sulaiman SA, Hassali MA, Lee CKC. Facilitators and Barriers Affecting Adherence Among People Living With HIV/AIDS: A Qualitative Perspective. J Patient Exp 2018; 6:33-40. [PMID: 31236449 PMCID: PMC6572934 DOI: 10.1177/2374373518770805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: It is widely accepted that for HIV-positive persons on highly active antiretroviral treatment, high levels of adherence to treatment regimens are essential for promoting viral suppression and preventing drug resistance. Objectives: This qualitative study examines factors affecting the adherence to HIV/AIDS treatment among patients with HIV/AIDS at a local hospital in Malaysia. Methods: The data from purposefully selected patients were collected by in-depth interviews using a pretested interview guide. Saturation was reached at the 13th interview. All interviews were audio-taped and transcribed verbatim for analysis using thematic content analysis. Results: Fear and stigma of perceived negative image of HIV diagnosis, lack of disease understating, poor support from the community, and perceived severity or the treatment side effects were among the reasons of nonadherence. Appropriate education and motivation from the doctors and reduction in pill burden were suggested to improve adherence. Conclusion: Educational interventions, self-management, and peer and community supports were among the factors suggested to improve adherence. This necessitates uncovering efficient ways to boost doctor–patient communication and recognizing the role of support group for the social and psychological well-being of the patients.
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Affiliation(s)
- Syed Imran Ahmed
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.,School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Kuala Lumpur, Malaysia
| | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Kuala Lumpur, Malaysia
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Gudina EK, Teklu AM, Berhan A, Gebreegziabhier A, Seyoum T, Nega A, Medhin G, Kebede A, Assefa Y. Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals. Ethiop J Health Sci 2018; 27:39-52. [PMID: 28465652 PMCID: PMC5402801 DOI: 10.4314/ejhs.v27i1.5s] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia. METHODS This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity. RESULT ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems - the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity. CONCLUSION ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available.
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Affiliation(s)
| | | | - Asres Berhan
- Department of Pharmacology, Hawassa University, Hawassa
| | | | - Teshome Seyoum
- Department of Internal Medicine, Hiwot Fana Hospital, Harar
| | - Abiy Nega
- MERQ Consultancy Services, Addis Ababa, Ethiopa
| | | | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa
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van Graan R, Viljoen M, Rheeders M, Motara F. Retrospective clinical analysis of adverse drug reactions associated with antiretroviral therapy in Tlokwe district, South Africa. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2017.1364013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Rentia van Graan
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Michelle Viljoen
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Malie Rheeders
- Centre of Excellence for Pharmaceutical Sciences (PharmaCen), Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Fadeela Motara
- Potchefstroom Hospital, Pharmacy, Potchefstroom, South Africa
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Alexoudi I, Katsarou A, Paparizos V, Oikonomou K, Kourkounti S, Augerinou G, Antoniou C. Dermatological conditions associated with HIV medication in a cohort of Greek patients initiating antiretroviral therapy: 1988–2013. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30238-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dermatological conditions associated with HIV medication in a cohort of Greek patients initiating antiretroviral therapy: 1988-2013. J Virus Erad 2018; 4:26-29. [PMID: 29568550 PMCID: PMC5851181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: Treatment of HIV infection has evolved from a single antiretroviral agent to combination therapy, which has dramatically improved both the quality of life and life expectancy of affected patients. The aim of this study was to review HIV treatment-associated dermatological conditions observed in adult patients receiving antiretroviral therapy (ART) in a single tertiary care referral centre over time. Methods: We reviewed the files of HIV-positive patients seen at the Dermatology Department, AIDS Clinic of the Andreas Syggros Hospital, Athens, Greece who had initiated ART from 1988 to 2013, for evidence of dermatological conditions commonly associated with HIV-related medication. Results: Among a cohort of 1329 HIV-positive patients (1155 men and 174 women), 352 (299 men and 53 women) presented with at least one dermatological condition, with a total of 423 conditions diagnosed that could be attributed to HIV-related medication. Lipodystrophy (47.42%), and maculopapular (MP) rash (40.6%) were most commonly diagnosed. There were three incidence peaks for these reactions, which reflected the different types of ART and HIV-related drugs commonly used at the time. After 2006, the number of these dermatological conditions declined (15.1% of cases) with the availability of newer ART regimens. Conclusions: Early ART was accompanied with a high incidence of adverse skin reactions, which have decreased over time in association with overall better tolerated treatment regimens for HIV infection.
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Bandeira ACPCS, Elias DBD, Cavalcante MG, Lima DGL, Távora LGF. Antiretroviral changes during the first year of therapy. Rev Assoc Med Bras (1992) 2017; 63:606-612. [PMID: 28977086 DOI: 10.1590/1806-9282.63.07.606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/14/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. METHOD This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. RESULTS From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). CONCLUSION The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.
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Affiliation(s)
| | - Darcielle Bruna Dias Elias
- PhD in Drug Development and Technological Innovation, Universidade Federal do Ceará (UFC). Managing Pharmacist, HSJ Laboratory, Fortaleza, CE, Brazil
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Kouotou EA, Nansseu JR, Ngono VN, Tatah SA, Zoung-Kanyi Bissek AC, Ndjitoyap Ndam EC. Prevalence and Clinical Profile of Drug Eruptions among Antiretroviral Therapy-Exposed HIV Infected People in Yaoundé, Cameroon. Dermatol Res Pract 2017; 2017:6216193. [PMID: 28744306 PMCID: PMC5506463 DOI: 10.1155/2017/6216193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prevalence and incidence of drug eruptions vary around the world and are influenced by some key factors including HIV infection. OBJECTIVE This study aimed to find the peculiarities of drug eruptions in people living with HIV (PLHIV) and on antiretroviral therapy (ART). METHODS This was a retrospective cross-sectional study including ART-taking PLHIV, aged 15+ years, followed up between January 2010 and December 2014 at the day-care unit of the Yaoundé Central Hospital, and who presented with drug eruptions after ART initiation. RESULTS Of 6,829 ART-experiencing PLHIV, 41 presented with drug eruptions, giving a prevalence of 0.6%. The M/F sex ratio equaled 0.17. The mean age was 41.07 ± 11.36 years. Benign drug eruptions accounted for 83.3%. Milder forms were essentially maculopapular exanthema (36.6%), fixed pigmented erythema (7.3%), and urticaria (4.9%). Severe forms were represented by multiform erythema (4.9%), toxic epidermal necrolysis (2.4%), and drug hypersensitivity syndrome (2.4%). The Zidovudine + Lamivudine + Efavirenz ART-protocol was received by 48.8% of patients and 69% of patients were receiving Cotrimoxazole prophylaxis. Nevirapine, Efavirenz, Zidovudine, and Cotrimoxazole were suspected as the potential causes in 43.7%, 4.8%, 2.4%, and 26.8% of cases, respectively. CONCLUSION Drug eruptions seem infrequent among ART-exposed HIV infected adult Cameroonians.
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Affiliation(s)
- Emmanuel Armand Kouotou
- Biyem-Assi District Hospital, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jobert Richie Nansseu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Vanessa Nancy Ngono
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Sandra A. Tatah
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Peter JG, Lehloenya R, Dlamini S, Risma K, White KD, Konvinse KC, Phillips EJ. Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:547-563. [PMID: 28483310 PMCID: PMC5424615 DOI: 10.1016/j.jaip.2017.01.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 12/17/2022]
Abstract
Most immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCARs) are an uncommon, potentially life-threatening, and challenging subgroup of IM-ADRs with diverse clinical phenotypes, mechanisms, and offending drugs. T-cell-mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis, although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short- and long-term morbidity/mortality and the potential need to treat ongoing comorbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive, diagnostic, treatment, and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying comorbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management.
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Affiliation(s)
- Jonathan Grant Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kimberly Risma
- Division of Allergy, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katie D White
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Katherine C Konvinse
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
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Stewart A, Lehloenya R, Boulle A, de Waal R, Maartens G, Cohen K. Severe antiretroviral-associated skin reactions in South African patients: a case series and case-control analysis. Pharmacoepidemiol Drug Saf 2016; 25:1313-1319. [PMID: 27464823 DOI: 10.1002/pds.4067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/23/2016] [Accepted: 06/28/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE Severe skin reactions may complicate combination antiretroviral therapy (cART). Nevirapine is known to be associated with severe skin reactions, but there are conflicting data on risk factors in African patients. We reviewed cases of severe skin reactions admitted to a tertiary hospital in Cape Town, South Africa. We identified associations with severe skin reactions in patients on cART. METHODS We described severe skin reaction cases in patients taking cART admitted to Groote Schuur Hospital in Cape Town, South Africa, between 2006 and 2012. We included those patients who developed a severe skin reaction within 120 days of cART initiation in a case-control analysis. We identified control patients matched on date of cART initiation and primary care facility by linkage with the Western Cape electronic provincial HIV database. We conducted a conditional (fixed effects) logistic regression modelling. RESULTS We identified 169 severe skin reactions in patients on cART. The most common presentations were Stevens Johnson syndrome/toxic epidermal necrolysis (49%) and drug hypersensitivity syndrome (36%). One hundred forty-one patients were female, of which 27 were pregnant. Median duration of hospitalization was 12 days (interquartile range 8 to 19) and six patients died. We included 91 cases and 361 matched controls in the analysis. Severe skin reaction was associated with nevirapine exposure, adjusted odds ratio of 7.6 (95%CI 3.7 to 15.7) and with pregnancy, adjusted odds ratio 3.7 (95%CI 1.3 to 10.8) compared with men. CONCLUSIONS Severe skin reactions resulted in prolonged admission to hospital in this setting. We found that nevirapine use and pregnancy are independently associated with severe skin reaction. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Annemie Stewart
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew Boulle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Health Impact Assessment Directorate, Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa.,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Renee de Waal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Mann M, Mengistu A, Gaeseb J, Sagwa E, Mazibuko G, Baeten JM, Babigumira JB, Garrison LP, Stergachis A. Sentinel site active surveillance of safety of first-line antiretroviral medicines in Namibia. Pharmacoepidemiol Drug Saf 2016; 25:1052-60. [PMID: 27134056 DOI: 10.1002/pds.4022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Active surveillance pharmacovigilance systems better estimate the burden of adverse events (AEs) and can generate useful information on risk factors of AEs for more effective medicine use, especially in conjunction with introduction of new medicines and/or changes in treatment guidelines. This project aimed to implement an active surveillance pilot program for first-line antiretroviral therapy (ART) at sentinel sites in Namibia. METHODS Sentinel sites were outpatient ART clinics at the Windhoek Central Hospital and Katutura Intermediate Hospital. An active surveillance data collection form was developed and placed into patient charts. HIV+ adults naïve to ART were enrolled. Physicians recorded ART and health information during each follow-up visit, including presence or absence of AEs. RESULTS A total of 413 patients were included from August 2012 to April 2013. Average age was 37 years; 51% of patients were at WHO clinical stage 1; and mean baseline CD4 count was 216. The most common ART regimen was tenofovir/lamivudine/nevirapine. Presence or absence of AEs was recorded in active surveillance forms for 94% of first follow-up visits. In total, 66 patients experienced 119 AEs of any severity. Incidence of experiencing at least one AE was 33/100 person-years. Most common AEs were rash and abdominal pain. On active surveillance forms, demographic variables were missing in 14% of patients, and follow-up visits were recorded for 82% of patients. CONCLUSIONS Completeness of AE recording on active surveillance forms was high. With improved logistical considerations, such as incorporation of active surveillance forms into medical records, long-term active surveillance programs could be successful. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marita Mann
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Assegid Mengistu
- Therapeutics Information and Pharmacovigilance Centre, Windhoek, Namibia
| | | | - Evans Sagwa
- Systems for Improved Access to Pharmaceutical and Services (SIAPS/Namibia), Management Sciences for Health, Windhoek, Namibia
| | - Greatjoy Mazibuko
- Systems for Improved Access to Pharmaceutical and Services (SIAPS/Namibia), Management Sciences for Health, Windhoek, Namibia
| | - Jared M Baeten
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Louis P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Andy Stergachis
- Department of Pharmacy, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Adverse Drug Reactions and Clinical Outcomes in Patients Initiated on Antiretroviral Therapy: A Prospective Cohort Study From Ethiopia. Drug Saf 2016; 38:629-39. [PMID: 26008986 DOI: 10.1007/s40264-015-0295-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In Ethiopia, the use of antiretroviral therapy (ART) has been scaled up for HIV/AIDS over the past decade. Adverse drug reactions (ADRs) associated with ART pose a unique challenge in the treatment of the infection in this resource-limited setting. OBJECTIVES The aims of this study were to examine the incidence and nature of ADRs, identify the risk factors associated with the development of ADRs, and assess their impact on treatment outcomes. METHODS A prospective cohort study was conducted in adult patients (≥18 years of age) with HIV/AIDS who commenced ART. All ADRs in the first 12 months of therapy were recorded, and the severity, causality, and preventability assessed. The impact of severe ADRs on self-reported adherence, immunological, and body mass index (BMI) outcomes were assessed. RESULTS Of the 211 patients included in the analysis, 181 (85.7 %) experienced at least one ADR and 66 (31.3 %) experienced at least one severe ADR within 12 months of commencing ART (incidence rates for any ADR and severe ADR of 14.8 and 3.2 per 100 person-months, respectively). Logistic regression analysis indicated that taking zidovudine-containing regimens (odds ratio [OR] 4.2, 95 % confidence interval [CI] 2.1-8.4) or being unemployed (OR 2.2, 95 % CI 1.1-4.3) were independent predictors of experiencing severe ADRs. Patients who experienced a severe ADR were less likely (OR 0.4, 95 % CI 0.2-0.9) to be ≥90 % adherent to ART. The mean gain in BMI was significantly lower in patients with severe ADRs after 3 and 12 months of therapy. CONCLUSIONS ADRs were common within the first 3 months in patients initiated on ART. Severe ADRs were negatively associated with self-reported adherence and gain in BMI. Measures need to be implemented to routinely monitor for severe ADRs to improve ART adherence and treatment outcomes.
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Jiamsakul A, Kerr SJ, Ng OT, Lee MP, Chaiwarith R, Yunihastuti E, Van Nguyen K, Pham TT, Kiertiburanakul S, Ditangco R, Saphonn V, Sim BLH, Merati TP, Wong W, Kantipong P, Zhang F, Choi JY, Pujari S, Kamarulzaman A, Oka S, Mustafa M, Ratanasuwan W, Petersen B, Law M, Kumarasamy N. Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD. Trop Med Int Health 2016; 21:662-74. [PMID: 26950901 DOI: 10.1111/tmi.12690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. METHODS Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant. RESULTS Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P < 0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (P = 0.158). CONCLUSIONS Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption.
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Affiliation(s)
| | - Stephen J Kerr
- The Kirby Institute, UNSW Australia, Sydney, Australia.,HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Global Health, Academic Medical Center, University of Amsterdame, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Oon Tek Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Romanee Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Evy Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | | | | | - Vonthanak Saphonn
- National Center for HIV/AIDS, Dermatology & STDs and University of Health Sciences, Phnom Penh, Cambodia
| | | | | | - Wingwai Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Shinichi Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Winai Ratanasuwan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
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Vishnu P, Aboulafia DM. Haematological manifestations of human immune deficiency virus infection. Br J Haematol 2015; 171:695-709. [PMID: 26452169 DOI: 10.1111/bjh.13783] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early in the human immunodeficiency virus (HIV) epidemic, infected patients presented to medical attention with striking abnormalities in each of the major blood cell lineages. The reasons for these derangements remain complex and multifactorial. HIV infects multipotent haematopoietic progenitor cells and establish latent cellular reservoirs, disturbs the bone marrow microenvironment and also causes immune dysregulation. These events lead to cytokine imbalances and disruption of other factors required for normal haematopoiesis. Activation of the reticulo-endothelial system can also result in increased blood cell destruction. The deleterious effects of medications, including first and second generation anti-retroviral agents, on haematopoiesis were well documented in the early years of HIV care; in the current era of HIV-care, the advent of newer and less toxic anti-retroviral drugs have had a more beneficial impact on haematopoiesis. Due to impaired regulation of the immune system and potential side effects of one or more anti-retroviral agents, there is also an increase in coagulation abnormalities such as thromboembolism, and less frequently, acquired disorders of coagulation including thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura and acquired inhibitors of coagulation. In this article we review the epidemiology and aetiology of select non-oncological haematological disorders commonly seen in people living with HIV-acquired immune deficiency syndrome.
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Affiliation(s)
- Prakash Vishnu
- Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA.,Division of Hematology, University of Washington, Seattle, WA, USA
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Tetteh RA, Nartey ET, Lartey M, Mantel-Teeuwisse AK, Leufkens HGM, Nortey PA, Dodoo ANO. Adverse events and adherence to HIV post-exposure prophylaxis: a cohort study at the Korle-Bu Teaching Hospital in Accra, Ghana. BMC Public Health 2015; 15:573. [PMID: 26092496 PMCID: PMC4474444 DOI: 10.1186/s12889-015-1928-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/10/2015] [Indexed: 12/05/2022] Open
Abstract
Background There is strong evidence that post-exposure prophylaxis (PEP) with antiretroviral drugs in the timely management of occupational exposures sustained by healthcare workers decreases the risk of HIV infection and PEP is now widely used. Antiretroviral drugs have well documented toxicities and produce adverse events in patients living with HIV/AIDS. In the era of “highly active antiretroviral therapy”, non-adherence to treatment has been closely linked to the occurrence of adverse events in HIV patients and this ultimately influences treatment success but the influence of adverse events on adherence during PEP is less well studied. Methods Following the introduction of a HIV post-exposure prophylaxis program in the Korle-Bu Teaching Hospital in January 2005, the incidence of adverse events and adherence were documented in occupationally-exposed healthcare workers (HCWs) and healthcare students (HCSs). Cohort event monitoring was used in following-up on exposed HCWs/HCSs for the two study outcomes; adverse events and adherence. All adverse events reported were grouped by MedDRA system organ classification and then by preferred term according to prophylaxis regimen. Adherence was determined by the completion of prophylaxis schedule. Cox proportional regression analysis was applied to determine the factors associated with the cohort study outcomes. Differences in frequencies were tested using the Chi square test and p < 0.05 was considered statistically significant. Results A total of 228 exposed HCWs/HCSs were followed up during the study, made up of 101 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 3 days; 75 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 28 days; and 52 exposed HCWs/HCSs administered lamivudine/zidovudine/lopinavir-ritonavir (3TC/AZT/LPV-RTV) for 28 days. The frequency of adverse events was 28 % (n = 28) in exposed HCWs/HCSs administered 3TC/AZT for 3 days, 91 % (n = 68) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 96 % (n = 50) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. Nausea was the most commonly reported adverse events in all three regimens. Adherence was complete in all exposed HCWs/HCSs administered 3TC/AZT for 3days, 56 % (n = 42) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 62 % (n = 32) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. In the Cox regression multi-variate analysis, exposed HCWs/HCSs administered 3TC/AZT for 3 days were 70 % less likely to report adverse events compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 0.30 [95 % CI, 0.18-0.48], p < 0.001). Exposed HCWs/HCSs administered 3TC/AZT for 3 days were 75 % more likely to adhere to the schedule compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 1.75 [95 % CI, 1.16-2.66], p = 0.008). Conclusion The intolerance to adverse events was cited as the sole reason for truncating PEP, thereby indicating the need for adequate, appropriate and effective counselling, education, active follow-up (possibly through mobile /phone contact) and management of adverse events. Education on the need to complete PEP schedule (especially for exposed HCWs/HCSs on 28-day schedule) can lead to increased adherence, which is very critical in minimizing the risk of HIV sero-conversion. The present results also indicate that cohort event monitoring could be an effective pharmacovigilance tool in monitoring adverse events in exposed HCWs/HCSs on HIV post-exposure prophylaxis.
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Affiliation(s)
- Raymond A Tetteh
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. .,Pharmacy Department, Korle-Bu Teaching Hospital, P.O. Box KB 77, Korle-Bu, Accra, Ghana.
| | - Edmund T Nartey
- World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
| | - Margaret Lartey
- Department of Medicine, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
| | - Aukje K Mantel-Teeuwisse
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
| | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. .,Medicines Evaluation Board, Utrecht, The Netherlands.
| | - Priscilla A Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana.
| | - Alexander N O Dodoo
- World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
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Khan K, Khan AH, Sulaiman SA, Soo CT, Akhtar A. Adverse Drug Reactions in HIV/AIDS Patients at a Tertiary Care Hospital in Penang, Malaysia. Jpn J Infect Dis 2015; 69:56-9. [PMID: 26073728 DOI: 10.7883/yoken.jjid.2014.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the current study we explored the occurrence of adverse drug reactions (ADRs) to antiretroviral therapy among human immune-deficiency virus (HIV)/AIDS patients. We concluded an observational retrospective study in all patients who were diagnosed with HIV infection and were receiving highly active antiviral therapy from Jan. 2007 to Dec. 2012 at Hospital Pulau Pinang, Malaysia. Patient socio-demographic details along with clinical features and susceptible ADRs were observed during the study period. Out of 743 patients, 571 (76.9%) were men, and 172 (23.1%) were women. Overall 314 (42.2%) patients experienced ADRs. A total of 425 ADRs were reported, with 311 (73.1%) occurring in men and 114 (26.8%) in women, with a significant statistical relationship (P value (P) = 0.02, OR = 1.21). Overall 239 (56.2%) ADRs were recorded among Chinese, 94 (22.1%) in Malay, and 71 (16.7%) in Indian patients, which had a statistically significant association with ADRs (P = 0.05, OR = 1.50). Out of a total 425 among ADRs, lipodystrophy was recorded in 151 (35.5%) followed by skin rashes in 80 (18.8%), anemia in 74 (17.4%), and peripheral neuropathy in 27 (6.3%) patients. These findings suggest a need of intensive monitoring of ADRs in HIV treatment centres across Malaysia.
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Affiliation(s)
- Kashifullah Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia
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Firnhaber C, Smeaton LM, Grinsztejn B, Lalloo U, Faesen S, Samaneka W, Infante R, Rana A, Kumarasamy N, Hakim J, Campbell TB. Differences in antiretroviral safety and efficacy by sex in a multinational randomized clinical trial. HIV CLINICAL TRIALS 2015; 16:89-99. [PMID: 25979186 PMCID: PMC4604209 DOI: 10.1179/1528433614z.0000000013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Worldwide, 50% of human immunodeficiency virus (HIV)-infected people are women. This study was to evaluate whether the safety and efficacy outcomes of three initial antiretroviral regimens (ARVs) differed by sex. METHODS Antiretroviral regimen naive participants from nine countries in four continents were assigned to ARVs with efavirenz (EFV) plus lamivudine-zidovudine, atazanavir (ATV) plus didanosine (ddI)-EC/emtricitabine (FTC) or EFV plus FTC-tenofovir-DF. The primary objective was to estimate the sex difference on efficacy outcome of treatment failure defined as one of the following: 1. Time to 1st of confirmed virologic failure, 2. WHO Stage 4 progression or 3. death with hazard ratio (HR) and 95% confidence interval (CI) from adjusted Cox regression models. RESULTS In all, 739 (47%) women and 832 (53%) men with HIV were evaluated. Women had higher pretreatment CD4+(182 vs 165 cells/mm(3); P < 0.001) and lower HIV-1 RNA (4.9 log10 vs 5.2 log10 copies/ml; P < 0.001) compared to men. Association of sex with time to regimen failure differed by treatment arm (P = 0.018). For atazanavir plus didanosine-EC plus emtricitabine, women had a longer time to treatment failure compared to men [adjusted HR (aHR) = 0.59; 95% CI 0.40-0.87]. Women were less likely to prematurely discontinue treatment prematurely (aHR = 0.74; 95% CI 0.56-0.98). Women assigned to efavirenz plus lamivudine-zidovudine were more likely to have a primary safety event compared to men (aHR = 1.49; 95% CI 1.18-1.88). CONCLUSION Antiretroviral efficacy and safety differed by sex in this study. Consideration of potential effects of sex on antiretroviral outcomes is important for the design of future clinical trials and for HIV treatment guidelines.
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Affiliation(s)
- Cynthia Firnhaber
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care Johannesburg, South Africa
| | - Laura M. Smeaton
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, United States of America
| | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Umesh Lalloo
- Durban University of technology, Durban, South Africa
| | - Sharla Faesen
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Aadia Rana
- Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | - James Hakim
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Thomas B. Campbell
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, United States of America
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Mulu W, Gidey B, Chernet A, Alem G, Abera B. Hepatotoxicity and associated risk factors in HIV-infected patients receiving antiretroviral therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. Ethiop J Health Sci 2015; 23:217-26. [PMID: 24307821 PMCID: PMC3847531 DOI: 10.4314/ejhs.v23i3.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females). Methods A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen. Results Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1–4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 –2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36–3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15–3.74) independently predicts the elevation of ALT. Conclusions In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.
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Affiliation(s)
- Wondemagegn Mulu
- Department of Medical Microbiology, Immunology and Parasitology, Bahirdar University, Ethiopia
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Masenyetse LJ, Manda SOM, Mwambi HG. An assessment of adverse drug reactions among HIV positive patients receiving antiretroviral treatment in South Africa. AIDS Res Ther 2015; 12:6. [PMID: 25745501 PMCID: PMC4349753 DOI: 10.1186/s12981-015-0044-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/02/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has been effective in reducing HIV/AIDS related morbidity and mortality. However, the use and uptake of ART has resulted in adverse reactions, due mainly to the medicine's toxicity and interactions with other medicines. The timing of adverse drug reactions (ADRs) among these patients is a critical public health issue for antiretroviral (ARV) treatment adherence and retention. Reliable monitoring of HIV patients on ART is through a structured pharmacovigilance surveillance system. However, recurrent nature of these data pose challenges in their analyses. This study aimed at modelling the timing of ADR events in HIV patients on ART using correlated time-to-event models. METHODS The data concern 590 HIV patients registered onto the Medunsa National ARV Pharmacovigilance Surveillance System within 6 months of ART initiation between February 2007 and July 2011. Recurrent times of ADRs and baseline characteristics: patient gender, and age, ART regimen, clinic and initiation period were extracted from the data. The recurrent ADR events data were modelled using both shared frailty and marginal models on the five patients' characteristics as covariates. RESULTS Out of 590 patients, 67% were female, 68% started on regimen: Stavudine, Lamivudine and Efavirenz; 37% had experienced at least one ADR and 67% started ART in 2009-2011. Age (p-value = 0.0210), clinic (p-value < 0.0001) and period of ART initiation (p-value = 0.0002) were significantly associated with timing of first ADR. There was a significantly higher rates of ADR recurrences in patients aged 38-44 years [HR = 2.45; 95% CI = (1.47; 4.10)] vs. 30 years and less, patients taking regimen: Zidovudine, Lamivudine and Nevarapine) vs. regimen: Stavudine, Lamivudine and Efavirenz [HR = 2.09; 95% CI = (1.35; 3.22)], while the rate was lower among those who started ART in 2009-2011 vs. those who initiated in 2007-2008 [HR = 0.55; 95% CI = (0.40; 0.76)]. CONCLUSION More realistic time-to-event models for recurrent events data have been used to analyse timing of ADR events in HIV patients taking ARV treatment. Age, antiretroviral regimen type and period of initiation of ART were associated with the timing of HIV/AIDS drug related adverse reactions regardless of the analysis model used. This study has public health policy implications in addressing the added morbidity among HIV patients taking ARV treatment in the context of universal scaling up of ARV treatment.
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Martin C, Poudel-Tandukar K, Poudel KC. HIV symptom burden and anemia among HIV-positive individuals: cross-sectional results of a community-based positive living with HIV (POLH) study in Nepal. PLoS One 2014; 9:e116263. [PMID: 25551656 PMCID: PMC4281119 DOI: 10.1371/journal.pone.0116263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background Previous research has reported high rates of anemia in people living with HIV/AIDS (PLWHA) in hospital or tertiary care settings. The objective of this community-based study was to measure the prevalence of anemia and describe the risk factors, with a specific emphasis on HIV symptom burden, in PLWHA in the Kathmandu Valley, Nepal. Methods We conducted a cross-sectional survey of 319 PLWHA residing in the Kathmandu Valley, Nepal. We recruited participants from five non-governmental organizations in the Kathmandu Valley. Descriptive statistics and multivariable logistic regression analyses were used. Results Our study found a 55.8% prevalence of anemia in PLWHA in the Kathmandu Valley. The prevalence of anemia among the participants with first, second, third, and fourth quartiles of HIV symptom burden was 44.8%, 49.3%, 60.3%, and 69.6%, respectively. Compared to the participants with lowest level of HIV symptom burden, the participants with highest level of HIV symptom burden were more likely to have anemia (adjusted odds ratio = 2.14; 95% confidence interval = 1.07 to 4.30). Conclusion Due to a high prevalence of anemia in a community-based sample of PLWHA, HIV patients should be counseled on their risk of developing anemia and encouraged to seek timely care for HIV symptoms.
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Affiliation(s)
- Catherine Martin
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Kalpana Poudel-Tandukar
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Krishna C. Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
- * E-mail:
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Melesse DY, Becker M, McClarty LM, Hodge K, Thompson LH, Blanchard JF, Kaufert J. Programmatic and ethical challenges in the implementation of treatment-as-prevention in the context of HIV and drug-resistant tuberculosis co-infection in sub-Saharan Africa. Glob Public Health 2014; 11:336-347. [PMID: 25513964 DOI: 10.1080/17441692.2014.988164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is limited literature on programmatic challenges in the implementation of a treatment-as-prevention (TasP) strategy among human immunodeficiency virus (HIV) and drug-resistant tuberculosis (DR-TB) co-infected individuals in sub-Saharan Africa (SSA). This paper highlights specific programmatic challenges surrounding the implementation of this strategy among HIV and DR-TB co-infected populations in SSA. In SSA, limitations in administrative, human and financial resources and poor health infrastructure, as well as increased duration and complexity of providing long-term treatment for HIV individuals co-infected with DR-TB, pose substantial challenges to the implementation of a TasP strategy and warrant further investigation. A comprehensive approach must be devised to implement TasP strategy, with special attention paid to the sizable HIV and DR-TB co-infected populations. We suggest that evidence-informed and human rights-based guidelines for participant protection and strategies for programme delivery must be developed and tailored to maximise the benefits to those most at risk of developing HIV and DR-TB co-infection. Assessing regional circumstances is crucial, and TasP programmes in the region should be complemented by combined prevention strategies to achieve the intended goals.
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Affiliation(s)
- Dessalegn Y Melesse
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Marissa Becker
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Leigh M McClarty
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Kellee Hodge
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Laura H Thompson
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - James F Blanchard
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Joseph Kaufert
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
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Tadesse WT, Mekonnen AB, Tesfaye WH, Tadesse YT. Self-reported adverse drug reactions and their influence on highly active antiretroviral therapy in HIV infected patients: a cross sectional study. BMC Pharmacol Toxicol 2014; 15:32. [PMID: 24957052 PMCID: PMC4082293 DOI: 10.1186/2050-6511-15-32] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients on antiretroviral therapy have higher risk of developing adverse drug reactions (ADRs). The impact of ADRs on treatment adherence, treatment outcomes and future treatment options is quiet considerable. Thus, the purpose of this study was to describe the common self-reported ADRs and their impact on antiretroviral treatment. METHODS Cross-sectional study was conducted at antiretroviral therapy (ART) clinic of Gondar University Hospital. Semi-structured interview questionnaire was used to extract self-reported ADRs, socio-demographic, and psycho-social variables. Variables related to antiretroviral medication, laboratory values and treatment changes were obtained from medical charts. Chi-square and odds ratio with 95% confidence interval were used to determine the associations of dependent variables. RESULT A total of 384 participants were enrolled. At least one adverse drug reaction was reported by 345 (89.8%) study participants and the mean number of ADRs reported was 3.7 (±0.2). The most frequently reported ADRs were nausea (56.5%) and headache (54.9%). About 114 (31.0%) participants considered antiretroviral therapy to be unsuccessful if ADRs occurred and only 10 (2.6%) decided to skip doses as ADRs were encountered. Based on chart review, treatment was changed for 78 (20.3%) patients and from which 79% were due to documented ADRs (p = 0.00). Among them, CNS symptoms (27.4%) and anemia (16.1%) were responsible for the majority of changes. Around four percent of patients were non-adherent to ART. Non-adhered participants and those on treatment changes were not statistically associated with self-reported ADRs. Only unemployment status (AOR = 1.76 (1.15 - 2.70), p = 0.01) and ADR duration of less than one month (AOR = 1.95 (1.28-2.98), p = 0.001) were significantly associated with self-reported adverse effects of three or more in the multivariate analysis. CONCLUSION Self-reported ADRs to antiretroviral therapy are quite common. More of the reactions were of short lasting and their impact on adherence and treatment change were less likely. However, documented ADRs were the most prevalent reasons for ART switch. Moreover, the level of unemployment was a strong predictor of self-reported ADRs.
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Affiliation(s)
- Wondmagegn Tamiru Tadesse
- Department of Pharmacology, School of Medicine, Addis Ababa Science & Technology University, Addis Ababa, Ethiopia.
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Shet A, Antony J, Arumugam K, Kumar Dodderi S, Rodrigues R, DeCosta A. Influence of adverse drug reactions on treatment success: prospective cohort analysis of HIV-infected individuals initiating first-line antiretroviral therapy in India. PLoS One 2014; 9:e91028. [PMID: 24614165 PMCID: PMC3948746 DOI: 10.1371/journal.pone.0091028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Adverse drug reactions related to antiretroviral therapy (ART) remain a challenge in resource-limited settings, often causing significant morbidity and impaired adherence leading to treatment failure. This 2-year prospective study aimed to describe patterns and predictors of adverse reactions to first-line ART and assess the impact of these events on treatment success. METHODS Between 2010-2013, 321 ART-naïve eligible adults were enrolled at two clinics in southern India. ART regimens included zidovudine or stavudine plus lamivudine, plus nevirapine or efavirenz. Pill count adherence, immunological and virological monitoring, and laboratory-based adverse drug reactions were measured prospectively and analyzed. RESULTS Among 321 patients in the study, 289 (90.0%) patients experienced at least 1 adverse reaction, and 85 (26.5%) experienced at least 1 severe reaction. The incidence rate was 52 and 15 per 100 person-years for all reactions and severe reactions respectively. The cumulative incidence of zidovudine-induced anemia was 37.1% over 2 years. At 12 and 24 months, the proportion of patients with optimal adherence, undetectable viral load and CD4 counts >350 cells/mm3 were similar between patients who experienced or did not experience severe adverse drug reactions. CONCLUSIONS Our results highlight the high frequency of ART-related adverse drug reactions among individuals initiating first-line ART in India, underscoring the importance of detailed counseling and monitoring for maintaining ART durability. Severe drug-induced anemia needs to be addressed urgently with alternative first-line agents, and close laboratory surveillance. High treatment efficacy despite decreased drug safety seen here may be because patients have limited treatment options. Our results support the use of currently recommended safer first-line ART regimens that minimize the risk of severe life-threatening toxicities and provide for a better quality of life. TRIAL REGISTRATION ISRTCN Registry: ISRCTN79261738.
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Affiliation(s)
- Anita Shet
- Department of Pediatrics, St. John’s Medical College Hospital, Bangalore, India
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jimmy Antony
- Division of Public Health and Infection, St. John’s Research Institute, Bangalore, India
| | - Karthika Arumugam
- Division of Biostatistics, St. John’s Research Institute, Bangalore, India
| | - Sunil Kumar Dodderi
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Rashmi Rodrigues
- Department of Community Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Ayesha DeCosta
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
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Kadima JN, Mukanyangezi MF, Uwizeye CB. Effectiveness and safety of concurrent use of first-line antiretroviral and antituberculous drugs in rwanda. J Trop Med 2014; 2014:904957. [PMID: 24624142 PMCID: PMC3929278 DOI: 10.1155/2014/904957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/08/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Overlapping toxicity between drugs used for HIV and TB could complicate the management of HIV/TB coinfected patients, particularly those carrying multiple opportunistic infections. This study aimed to evaluate the clinical outcomes and adverse drug events in HIV patients managed with first-line antiretroviral and first-line anti-TB drugs. Methods. This is a retrospective study utilizing medical dossiers from single-HIV infected and HIV/TB coinfected patients already initiated on ART. Predictors of outcomes included changes in CD4 cells/mm(3), body weight, physical improvement, death rate, and adverse drug reactions. Results. Records from 60 HIV patients and 60 HIV/TB patients aged between 20 and 58 years showed that all clinical indicators of effectiveness were better in single-HIV infected than in HIV/TB coinfected patients: higher CD4 cell counts, better physical improvement, and low prevalence of adverse drug events. The most frequently prescribed regimen was TDF/3TC/EFV+RHZE. The mortality rate was 20% in HIV/TB patients compared to 8.3% in the single-HIV group. Conclusion. Treatment regimens applied are efficient in controlling the progression of the infection. However, attention should be paid to adjust dosing when combining nonnucleoside antiretrovirals (EFV and NVR) with anti-TB drugs to minimize the risk of death by drug intoxication.
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Affiliation(s)
| | | | - Claude Bernard Uwizeye
- Infectious Diseases Unit, Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda
- Rwanda Biomedical Centre, Kigali, Rwanda
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Chandra A, Firth J, Sheikh A, Patel P. Emergencies related to HIV infection and treatment (part 2). Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Agu KA, Oparah AC. Adverse drug reactions to antiretroviral therapy: Results from spontaneous reporting system in Nigeria. Perspect Clin Res 2013; 4:117-24. [PMID: 23833736 PMCID: PMC3700325 DOI: 10.4103/2229-3485.111784] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: This study evaluated the suspected adverse drug reactions (ADR) reported from a spontaneous reporting program in Human Immunodeficiency Virus (HIV) positive patients receiving antiretroviral therapy (ART) in Nigeria Materials and Methods: This descriptive study analyzed individual case safety reports (ICSRs) in HIV-positive patients receiving ART between January 2011 and December 2011 in 38 secondary hospitals. All ICSRs during this period were included. Chi-square was used to test the association between variables at 95% confidence interval. Results: From 1237 ICSRs collated, only 1119 (90.5%) were valid for analysis. Mean age of patients was 35.3 (95%CI, 35.1–35.5) years; and 67.1% were females. A total of 1679 ADR cases were reported, a mean (± Standard Deviation, SD) of 1.5 (± 0.8) ADR cases per patient. Of reported ADRs, 63.2%, 8.2% and 19.3% occurred in patients on Zidovudine-based, Stavudine-based and Tenofovir-based regimens, respectively. The commonest ADRs included (12.0%) peripheral neuropathy, (11.4%) skin rash, (10.1%) pruritus and (6.5%) dizziness. ADR occurrence was associated with ART regimens, concomitant medicines and age (P < 0.05) unlike gender. Anaemia was associated with Zidovudine (AZT)/ Lamivudine (3TC) /Nevirapine (NEV) regimen [Odds ratio, OR = 6.4 (3.0–13.8); P < 0.0001], and peripheral neuropathy with Stavudine (d4T)/3TC/NEV regimen [OR = 8.7 (5.8–30.0), P < 0.0001] and Tenofovir (TDF)/Emtricitabine (FTC)/Efavirenz (EFV) regimen [OR = 2.1 (1.0–4.1), P = 0.0446]. Skin rash and peripheral neuropathy were associated with patients aged < 15years [OR = 3.0 (1.3–6.6), P = 0.0056] and 45–59years [OR = 1.9 (1.3–2.7), P = 0.0006] respectively. Palpitation and polyuria were associated with Salbutamol [OR = 55.7 (4.9–349.6), P = 0.0000] and Nonsteroidal anti-inflammatory drugs (NSAIDS) [OR = 50.2 (0.9–562.1), P = 0.0040] respectively. Conclusion: ADRs were less likely to occur in patients on stavudine-based and tenofovir-based regimens compared to zidovudine-based regimens. Peripheral neuropathy was also found to be associated with tenofovir-based regimen. This may require further studies and evaluation.
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Affiliation(s)
- Kenneth A Agu
- Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, Nigeria
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