Abstract
Objective: Although all marketed antiretrovirals (ARVs) have proven efficacy, genetic differences can result in varied effectiveness. This study was conducted to determine the effectiveness of different Highly Active Antiretroviral Therapy (HAART) combinations among patients attending HIV clinic at a Major Teaching Hospital in Ghana.
 Methods: The study was a retrospective study involving 500 patients at an HIV clinic in the Ashanti Region of Ghana.
 Results: Twelve major antiretroviral combinations for HAART were prescribed at the study center. The most prescribed drug combinations were AZT+3TC+EFV and AZT+3TC+NVP. The study identified that HAART, irrespective of the kind of drug combination used, was effective at increasing CD4 count within the first 6 mo of therapy initiation in the study population. However, the magnitude of the increases differed from combination to combination. All HAART combinations with zidovudine as one of the drugs resulted in higher CD4 counts compared with combinations containing stavudine. HAART with nevirapine also resulted in a higher CD4 count than those with efavirenz. However, efavirenz-based combinations appeared to be more effective in critically ill patients and patients with mean CD4+T helper cells count below 100 cell/mm3. More importantly, efavirenz was common among all HAART combinations that resulted in treatment failure.
 Conclusion: There was significant variation in response to different HAART combination among Ghanaian HIV patients. However, there was no statistically significant difference in mean CD4 count between the two most predominately used HAART i. e AZT+3TC+EFV and AZT+3TC+NVP.
Highlights
The advent of Highly Active Antiretroviral Therapy has tremendously reduced Human Immunodeficiency Virus (HIV) morbidity and mortality [1, 2]
Typically three or four, are acquired in combination, the approach is known as Highly Active Antiretroviral Therapy (HAART) [3]
A study conducted in KATH confirmed AZT+3TC+EFV was the most commonly prescribed HAART followed by AZT+3TC+NVP [13]
Summary
The advent of Highly Active Antiretroviral Therapy has tremendously reduced HIV morbidity and mortality [1, 2]. Antiretroviral (ARV) are medications for the treatment of infection by retroviruses, primarily HIV. When such medicines, typically three or four, are acquired in combination, the approach is known as Highly Active Antiretroviral Therapy (HAART) [3]. All marketed ARVs have proven efficacy, patient variability as a result of genetic differences in response to drug action can result in varied effectiveness [5]. These variations have been identified as a major problem which can lead to either sub-therapeutic or supratherapeutic treatment outcomes [6]. It has been shown that there are variations in pharmacokinetics, efficacy and toxicity of ARVs among people of diverse ethnicity even at standard or recommended doses [8, 9]
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