A prospective, observational cohort study to elicit adverse effects of antiretroviral agents in a remote resource-restricted tribal population of Chhattisgarh

Harminder Singh,Pawan Tiwari,Prabhakar Singh,Navin Dulhani,Tiku Sinha

doi:10.4103/0253-7613.58512

Harminder Singh, Pawan Tiwari + Show 3 more

Open Access

https://doi.org/10.4103/0253-7613.58512

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Abstract

Objective:To assess the adverse effects of antiretroviral therapy (HAART) and its adherence in HIV-infected patients, in remote and tribal area with restricted resources.Materials and Methods:This was a prospective, observational study carried out at Department of Medicine, Government Medical College, Jagdalpur. A set of questions were asked and adverse drug reactions (ADRs) were recorded for every patient.Results:79 HIV positive patients were analyzed. Among them, 68 (86%) had at least one ADR. The mean ADR per patient was 1.64 (±1.09). The most common ADR in our study was peripheral neuropathy (20.83%), followed by skin rashes (15.83%). Twenty-one patients (26.58%) had severe (grade-3 and grade-4) ADRs. Female patients had more ADRs (45.71%) than males (11.36%); severe ADRs had a statistically significant positive correlation with sex and CD4 cell count of the patients.Conclusion:In spite of high ADRs, HAART is the only answer to HIV/AIDS; thus, management requires a highly precise balance between benefits of durable HIV suppression and the risks of drug toxicity to achieve the therapeutic goals, with conventional drugs or with newer less toxic agents.

Highlights

Universal access to antiretroviral therapy (ART) is the aim of World Health Organization and UNAIDS.[1]
The most common adverse drug reactions (ADRs) in our study was peripheral neuropathy (20.83%), followed by skin rashes (15.83%)
15 expired, 16 patients stopped the therapy midway, 9 were lost to follow up, and 18 patients were on antitubercular treatment (ATT) simultaneously and so were excluded from the study

Summary

Introduction

Universal access to antiretroviral therapy (ART) is the aim of World Health Organization and UNAIDS.[1] In June 1996, the World AIDS Conference in Vancouver reported new AIDS cocktails and ‘highly active antiretroviral therapy’ (HAART) became popular. Reduction in morbidity and mortality have been confirmed in all settings in which it has been used, including developing countries.[3] The choice of regimen depends on their side-effect, potential drug interactions, co-morbidities (e.g. tuberculosis, hepatitis), and alternative options in the setting of treatment failure and drug availability and cost.[3] The major individual toxicities include bone marrow suppression (zidovudine), pancreatitis (didanosine), hypersensitivity (abacavir), hepatic necrosis (nevirapine), neuropsychiatric complaints (efavirenz), and nephrolithiasis (indinavir). The present work was carried out to assess the ADR profile of HAART in a remote, tribal area with restricted resources

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Results

Conclusion