Antiretroviral Side Effects Research Articles

Correlation of Side Effects of ARV (Antiretroviral) Drugs with ARV Therapy Compliance in PLWHA at KDS Jombang Care Center Plus of Jombang Regency

Human Immunodeficiency Virus (HIV) attacks white blood cells, leading to a weakened immune system. Acquired Immune Deficiency Syndrome (AIDS) refers to the set of symptoms caused by the decline in immunity due to HIV. Antiretroviral therapy (ART) is used to suppress viral replication, with treatment success largely dependent on adherence to therapy. However, side effects of antiretroviral drugs can negatively impact adherence by causing unwanted symptoms that discourage patients from continuing treatment. This study aims to analyze the correlation between the side effects of antiretroviral drugs and adherence to antiretroviral therapy among people with HIV/AIDS in the Jombang Care Center Plus Peer Support Community, Jombang Regency. This study used a cross-sectional design with purposive sampling, involving 38 respondents. Adherence to ART was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire, while the side effects of antiretroviral drugs were evaluated using the Group Clinical Trial AIDS questionnaire. Statistical analysis was performed using Somers' D test. The Somers' D test showed a significant correlation between the side effects of antiretroviral drugs and adherence to therapy (p = 0.002, p < 0.05). This study concludes that side effects of antiretroviral drugs are significantly associated with adherence to antiretroviral therapy among people with HIV/AIDS in the Jombang Care Center Plus Peer Support Community.

Barriers and Enablers to Retention in HIV Care and Adherence to Antiretroviral Therapy: Evidence from Dar es Salaam, Tanzania.

To explore the enabling factors, barriers, and strategies to improve retention in HIV care and adherence to antiretroviral therapy (ART) among adults (18 years and above) living with HIV in Dar es Salaam, Tanzania. We conducted a descriptive qualitative study to better understand and explore enablers, barriers, and strategies to improve retention in HIV care and adherence to antiretroviral therapy (ART) among PLHIV in Dar es Salaam, Tanzania. Focus group discussions (FGD) were conducted with a semi-structured discussion guide between December 2021 and June 2022. A non-random purposive sampling technique was used to select PLHIV and people involved in provision of healthcare and socioeconomic support to PLHIV. Thematic analysis was used to identify and interpret the themes. Three major themes with 10 sub-themes emerged. Participants indicated that family and partner support, peer-support group/adherence clubs, and healthcare provider counselling on medication adherence facilitated retention and adherence to ART. In contrast, stigma and discrimination, financial constraints, disease outbreaks such as the COVID-19 pandemic, myths and misconceptions about HIV, and side effects of antiretrovirals were mentioned as barriers. Strengthening community and patient education about HIV and ART through peer support groups and financial support for poor PLHIV were the proposed mitigation. Addressing the challenges to ART adherence may require a more holistic approach. We recommend the implementation of peer support groups and financial support through small microfinance groups as interventions to increase retention in HIV care and adherence to ART in the study area.

Provider perspectives on antiretroviral therapy adherence among psychiatric inpatients in Botswana

Background: Optimal adherence to antiretroviral therapy (ART) is crucial for the effective management of HIV. Mental disorders often co-occur with HIV infection which often compromises ART adherence. Little is known about ART adherence in psychiatric settings in sub-Saharan Africa. Aims: This study aimed at exploring the health care providers’ perspectives on ART adherence among psychiatric inpatients. The study further assessed the facilitators and strategies enhancing ART adherence in hospitalised psychiatric patients. Methods: In-depth interviews were conducted with 25 health care providers at the Sbrana Psychiatric Hospital in Botswana. Interviews were focused on barriers and facilitators to psychiatric inpatients’ adherence to ART, and strategies and recommendations to support adherence. Data were manually analysed using a thematic analysis approach. Results: Key barriers were lack of insight, HIV-related stigma, lack of HIV-related knowledge, antiretroviral side effects and delays in re-initiating ART. Facilitators of ART adherence included motivation to be discharged from the hospital, fear of being sick, peer support, longer duration of hospitalisation, good provider-patient relationships, good diet, privacy and confidentiality and a single-tablet regimen. Health care providers described the various strategies currently used to support adherence, including directly observed therapy and family support, and recommended potential approaches to enhance psychiatric inpatient adherence to ART, including the use of injectable antiretrovirals and the introduction of halfway house centres. Conclusions: Findings from this study revealed unique insights into the numerous factors that influence ART adherence among psychiatric inpatients, and underscore the need to implement tailored strategies to support ART adherence in this population with complex health needs.

Abstract P187: Qualitative Description of Physical Activity Perceptions and Experiences in Older Adults With HIV

Background: The benefits of physical activity, and specifically exercise, among older adults are well known. Yet, globally there is concern regarding limited engagement in physical activity and rising cases of obesity and frailty among older people with HIV (PWH). We explored the experiences and perceptions of PWH enrolled in the High-intensity Exercise study to Attenuate Limitations and Train Habits (HEALTH) study. Methods: Thirty-two participants were enrolled between February 2021 and August 2022. We conducted in-depth interviews among sedentary, older PWH in the ongoing HEALTH (NCT04550676) study. A semi-structured interview guide was informed by the two minds theory, which frames behavior change as an intention-behavior gap between two neurocognitive systems. The intuitive system, described as immediate or first reactions, optimizes behavior based on its expected consequences at the moment, whereas the narrative system produces beliefs about possible behavior in the future sequentially and thoughtfully. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations and goals for physical activity. Interviews were transcribed verbatim, and a three-member study team employed deductive and inductive thematic analysis using Dedoose. The sample size provided sufficient data to reach saturation. Results: Physical activity was perceived as the ability to maintain daily living activities and address health goals such as becoming and maintaining physical fitness. Previous experiences with physical activity varied among participants and were influenced by chronic illnesses, motivation and interest in physical activity, and availability of social support. Congruent with the two-minds theory, participants reported intuitive-level experiences as barriers to physical activity. These include antiretroviral side effects, lack of self-confidence, and aging. COVID-19 was also noted as a significant barrier. Consistent with the narrative system, participants identified changes in health status, feeling better and having improved sleep, body changes (e.g., weight loss), and changes in relationships as reasons for and benefits of physical activity. Additionally, most participants reported lifestyle changes such as quitting substance use, diet changes, and changes to their social network, all of which helped sustain their increased physical activity. PWH felt that conversations with their healthcare providers supporting their exercise goals was critical to helping them engage in physical activity, but was rarely received. Conclusion: Understanding how older PWH experience and perceive physical activity is critical to developing tailored strategies and structuring service delivery within the healthcare setting to improve health by supporting a physically active life.

The Symptom Experience and Management in People with HIV Who Underwent Antiretroviral Therapy During the Covid-19 Pandemic in Bali, Indonesia

Antiretroviral (ARV) therapy does not only provide some benefits but also has side effects that cause symptoms experienced by people with HIV (PWH). Strategies for effective symptom management were needed, especially during the COVID-19 pandemic. The purpose of this study was to explore the symptom experience and management strategies in PWH during the COVID-19 pandemic. A qualitative phenomenology design was used. A cross-sectional with purposive and snowball sampling techniques was used from July to October 2021. Eight participants joined an in-depth interview based on the criteria of the participants, such as people who were infected with HIV, 18 years or older, on ARV therapy, and willing to sign the informed consent. Thematic analysis was used after data saturation was reached. Three themes were found in this study; 1) The symptoms of ARV side effects, which included physical and psychological symptoms that appeared in PWH; 2) The symptom management of ARV side effects, which described the history of hospitalization, pharmacological and non-pharmacological management; 3) The symptom condition during the COVID-19 pandemic. The symptom experience of ARV side effects required strategies to manage the appearance of the symptoms, especially those amid the COVID-19 pandemic. This study could become fundamental evidence to consider in providing nursing care to PWH and supporting the symptom management model among PWH further.

An hiv infection - a problem of quality of life!?

IntroductionThe quality of life is a multidiimensional and subjective construct, based on the patient’s experience.ObjectivesThe objective of this study is to observe if at the HIV - positive patient the quality of life in relation to health is a consequence of disease and treatment and if his perception about the disease changes his ability to have a full and useful life.MethodsWe centralized the data coming from a number of 600 patients registered in the Iasi Regional Center, for a period of 12 months. The side effects reported by the patients emerged from discussions with the infectious diseases specialist and the psychologist.ResultsFrom 600 pacients, 59% of them were male with mean age of 21.1 years old. Approximately 14% of the patiens had stable jobs, the rest were unemployed or had part-time jobs. 38% came from foster care units of from broken homes. The average number of days of hospitalization was 4 days, 25% of them were at their first scheme, 10% in the seventh-eighth scheme. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea in 15% of the cases; regarding the psychological aspects, 65% of patients showed an above level of anxiety, 40% had depressive manifestations, 10% had specific obsessions-compulsions and 10% neurotic and hysterical tendencies.ConclusionsWe need a close collaboration between the infectious diseases specialist and the psychologists in order to enhance the quality of life of the HIV patient.

Factors Related to Hair Antiretroviral Concentration: A Systematic Review of Global Literature.

Assessment of antiretroviral (ARV) concentration in hair (hair antiretroviral concentration [HAC]) is one of the latest non-invasive innovations for measuring long-term ARV adherence. We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to identify the factors that may affect the validity and reliability of HAC. This review included 25 studies that reported data on the associations of hair concentrations of 10 ARVs with 22 potential factors related to HAC. Notwithstanding scarce data and some inconsistencies, the data from existing studies suggested that (1) HAC was associated with hair types, hair segment position, housing, illegal drugs use, high-risk sexual behaviors, renal function, and genetic factors; (2) HAC was not associated with race/ethnicity, location of sample, ARV side effects, length of ARV treatment, smoking, alcohol use, orange consumption, depression, or anthropometry characteristics; and (3) the relationships of HAC with natural hair color, hair treatment, age, sex, dosing schedule, and liver function need further study. This review of factors related to HAC informed the design, analysis, and interpretation of the future HIV treatment and HIV prevention research utilizing hair concentrations of various ARVs as a biomarker of ARV adherence.

Implementation of the HIV Test-and-Treat Strategy in PEPFAR Supported Health Facilities in Yaoundé-Cameroon: Antiretroviral Side Effects, Retention and Viral Load Suppression Outcomes

Implementation of the HIV Test-and-Treat Strategy in PEPFAR Supported Health Facilities in Yaoundé-Cameroon: Antiretroviral Side Effects, Retention and Viral Load Suppression Outcomes

Nonadherence and unsuppressed viral load across adolescence among US youth with perinatally acquired HIV.

To identify factors associated with nonadherence and unsuppressed viral load across adolescence among youth with perinatally acquired HIV. Longitudinal study at 15 US clinical sites. Self-reported antiretroviral medication nonadherence (any missed dose, past week) and unsuppressed viral load (HIV RNA > 400 copies/ml) were assessed annually. Individual, caregiver, social, and structural factors associated with nonadherence and unsuppressed viral load were identified by age (years): 8-11 (preadolescence), 12-14 (early adolescence), 15-17 (middle adolescence), and 18-22 (late adolescence/young adulthood), utilizing multivariable generalized linear mixed effects models. During a median 3.3-year follow-up, 381 youth with perinatally acquired HIV contributed viral load measurements and 379 completed 1190 adherence evaluations. From preadolescence to late adolescence/young adulthood, prevalence of nonadherence increased from 31 to 50% (P < 0.001); prevalence of unsuppressed viral load increased from 16 to 40% (P < 0.001). In adjusted analyses, in pre, middle, and late adolescence/young adulthood, perceived antiretroviral side effects were associated with nonadherence. Additional factors associated with nonadherence included: in preadolescence, using a buddy system (as an adherence reminder); in early adolescence, identifying as black, using buddy system; in middle adolescence, CD4% less than 15%, unmarried caregiver, indirect exposure to violence, stigma/fear of inadvertent disclosure, stressful life events. Associations with unsuppressed viral load included: in early adolescence, youth unawareness of HIV status, lower income; in middle adolescence, perceived antiretroviral side effects, lower income; in late adolescence/young adulthood, distressing physical symptoms, and perceived antiretroviral side effects. Prevalence of nonadherence and unsuppressed viral load increased with age. Associated factors varied across adolescence. Recognition of age-specific factors is important when considering strategies to support adherence.

Non-nucleoside reverse transcriptase inhibitor levels among HIV-exposed uninfected infants at the time of HIV PCR testing - findings from a tertiary healthcare facility in Pretoria, South Africa.

IntroductionTo date, very little programmatic data has been published regarding serial antiretroviral (ARV) levels in infants exposed to maternal treatment and/or infant prophylaxis during the first months of life. Such data provide the opportunity to describe the proportion of infants exposed to virologically suppressive levels of ARVs and to gauge adherence to the prevention of mother‐to‐child transmission of HIV (PMTCT) programme.MethodsFrom August 2014 to January 2016, HIV‐exposed infants born at Kalafong Provincial Tertiary Hospital in Pretoria, South Africa were enrolled as part of an observational cohort study. Plasma samples from HIV‐exposed uninfected infants were obtained at birth, 6‐weeks, 10‐weeks and 14‐weeks of age and quantitative efavirenz (EFV) and nevirapine (NVP) drug level testing performed using liquid chromatography‐mass spectrometry, irrespective of maternal ARV regimen. Descriptive analysis of EFV and NVP levels in relation to self‐reported maternal and infant ARV exposure was performed. EFV levels >500 ng/mL and NVP levels >100 ng/mL were reported based on studies suggesting that trough levels above these thresholds are associated with virological suppression and PMTCT respectively.ResultsAmong 66 infants exposed to maternal EFV in utero, 29 (44%) had virologically suppressive plasma EFV levels at birth, with a median level of 1665 ng/mL (IQR: 1094 to 3673). Among infants who were exclusively breastfed at 6‐, 10‐ and 14 weeks, 13/48 (27%), 5/25 (25%) and 0/21 (0%) had virologically suppressive EFV levels. Among 64 infants whose mothers reported administering daily infant NVP at time of their 6‐week HIV PCR test, only 45 (70%) had NVP levels above the minimum prophylactic trough level.ConclusionsDuring the first 10‐weeks after delivery, a quarter of breastfed infants born to women on an EFV‐containing treatment regimen maintained virologically suppressive EFV plasma levels. This finding highlights the importance of both careful monitoring of ARV side effects and repeat HIV PCR after the first few months of life among HIV‐exposed uninfected infants. As 30% of infants had inadequate NVP plasma levels at 6‐weeks of age, adherence counselling to caregivers regarding infant prophylaxis needs to be enhanced to further reduce mother‐to‐child transmission of HIV.

ANTIRETROVIRAL SIDE EFFECT ON ADHERENCE IN PEOPLE LIVING WITH HIV AIDS AT DR. KARIADI GENERAL REFFERAL HOSPITAL SEMARANG CENTRAL JAVA

Background: Antiretroviral (ARV) therapy is a lifelong treatment in people living with HIV/AIDS (PLWHA). Adherence is the key to the effectiveness of antiretroviral therapy. ARV have side effects that may affect patient adherence.Purpose: The purpose of this study was to examine the impact of ARV side effects on drug adherence in PLWHA.Methods: This study used cross-sectional approach. Sample size in this study was 78 consist of people who were recruited by purposive sampling. These subjects received ARV therapy in Tropical Disease and Infection Polyclinic at General Hospital of Dr. Kariadi SemarangResult : Result showed that eta2 is 0,525625. It means that ARV side effect has impact on ARV adherence. Most of the side effects reported by the respondents were nausea and dizziness. Some respondents also reported experiencing weakness, difficult to concentrate, and diarrhea. Conclusion : Side effects have impact on patient’s ARV therapy adherence. Therefore health care provider for PLWHA should be able to recognize and concern on ARV side effect management.

The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge.

Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication. This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months. Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet. In a randomised controlled study, 116 limited literacy HIV patients taking ARVs were randomly allocated to either control (standard care) or intervention groups (standard care plus illustrated information). Side effect knowledge was assessed at baseline, and intervention patients received the illustrated leaflet. Knowledge was re-tested at one and three months. Interpretation of side effect pictograms was evaluated at one month. In intervention patients, mean side effect knowledge increased from 45.9% (baseline) to 95.7% (three months; p<0.0001), and pictogram interpretation was good. Knowledge did not change significantly in the control group. All found the pictograms clear and useful, and endorsed their routine use. Providing patients with simple written information containing pictograms on ARV side effects significantly improved side effect knowledge, sustained over time, in limited literacy, rural South African HIV patients.

EVALUATION ON THE NUMBER OF CD4 T CELLS AND ANTIRETROVIRAL SIDE EFFECTS IN PATIENTS WITH AIDS

Antiretroviral drug discovery has encouraged a revolution in the care of people living with HIV, although it has not been able to cure diseases and to increase the challenge in terms of drug side effects. Side effects of antiretroviral drugs are fairly common occurrences in HIV patients and generally occur within the first three months after initiation of antiretroviral therapy, although long-term side effects are also often found afterwards. This study aims to evaluate the number of CD4 T-cells in patients with AIDS before and after getting on ARV therapy and side effects arising during the taking of ARVs. Samples were collected from 10 patients infected by HIV/AIDS in a clinic in Surabaya. This study is an analytical survey. Data collection was conducted using secondary data obtained from the medical record card status on HIV paients in a clinic in Surabaya. Data results showed that the side effects that often occur in people with AIDS are appetite loss (90%), headache (80%), insomnia (80%) and nausea (70%). While many combinations of antiretroviral drugs have side effects such as a combination of AZT +3 TC + EFV, d4T +3 TC + followed by EFV and AZT +3 TC + NVP. The present study shows that combination antiretroviral therapy gives good results to the increased number of CD4 T-cellsin patients living with HIV, as shown by the tendency of an increase in the number of CD4 T-cells in 8 out of 10 AIDS patients who received a antiretroviral therapy.

Herb–drug interaction between an anti-HIV Chinese herbal SH formula and atazanavir in vitro and in vivo

Ethnopharmacological relevanceWith the prevalent use of highly active antiretroviral therapy (HAART) for AIDS patients since 1996, the mortality of HIV/AIDS patients has been remarkably decreased. With long-term use of HAART, drug resistance and side effects of antiretrovirals have been frequently reported, which not only reduce the efficacy, but also decreases the tolerance of patients. Traditional herbal medicine has become more popular among HIV/AIDS patients as adjuvant therapy to reduce these adverse effects of HAART. SH formula is a Chinese herbal formula consisting of five traditional Chinese herbs including Morus alba L., Glycyrrhiza glabra L., Artemisia capillaris Thumb., Astragalus membranaceus Bge., and Carthamus tinctorius L. SH formula is clinically used for HIV treatment in Thailand. However, the possible pharmacokinetic interactions between these Chinese herbs and antiretroviral drugs have not been well documented. The aim of this study was to investigate the potential herb-drug interaction between SH herbal Chinese formula and the antiretroviral drug atazanavir (ATV). Materials and methodsThe combination effect of SH formula and ATV on HIV protease was studied in HIV-1 protease inhibition assay in vitro. The inhibition of SH formula on rat CYP3A2 was assessed by detecting the formation of 1′–OH midazolam from midazolam in rat liver microsomes in vitro. The in vivo pharmacokinetic interaction between SH formula and ATV was investigated by measuring time-dependent plasma concentrations of ATV in male Sprague–Dawley rats with liquid chromatography–mass spectrometry. ResultsThrough the in vitro HIV-1 protease inhibition assay, combination of SH formula (41.7–166.7μg/ml) and ATV (16.7–33.3ng/ml) showed additive inhibition on HIV-1 protease activity than SH formula or ATV used alone. In vitro incubation assay indicated that SH formula showed a weak inhibition (IC50=231.2µg/ml; Ki=98.2µg/ml) on CYP3A2 activity in rat liver microsomes. In vivo pharmacokinetic study demonstrated that SH formula did not affect the metabolism of ATV in rats. ConclusionsOur study demonstrated for the first time that there is no metabolism-based herb-drug interaction between SH formula and ATV in rats, but this combination enhances the inhibition potentials against HIV protease activity. This observation may support the combinational use of anti-HIV treatment in human.

Provision of health care actions and services for the management of HIV/AIDS from the users' perspective

To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.

Local discourse on antiretrovirals and the lived experience of women living with HIV/AIDS in Thailand.

Antiretrovirals (ARVs) have been seen as life-saving for HIV-positive people. However, ARVs have a darker side. Since 2000, many HIV-positive people in Thailand have received ARV treatments, but the understanding of ARVs and practices of medication-taking among HIV-positive women have not received much attention. We discuss local discourses employed by HIV-positive women and health work by these individuals in their attempts to adhere to ARVs restrictions. The local discourse of ARVs was ya tan rok AIDS "medications that could resist HIV/AIDS." ARVs provided hope for the women. Although the women were affected by the side effects of ARVs, they continued to take their medication to be able to live longer and perform their duties as mothers and carers. They were more concerned about the practice of medication-taking. Understanding why these women were adherent to their ARVs offers insights into the social impact of these ARVs on their lives.

Post-exposure prophylaxis among Ugandan nurses: “Accidents do happen”

PurposeIn 2009 we conducted a study to explore Ugandan nurses’ practice of universal precautions while caring for persons living with HIV. During our interviews about universal precautions, nurses’ also shared their experience with post-exposure prophylaxis (PEP) following needle-stick injuries. We present findings related to nurses’ understanding of PEP and their experience with, and reporting of, needle stick injuries. BackgroundNurses have high rates of exposure to blood-borne pathogens. Although there is minimal risk of the transmission of blood-borne pathogens from health care workers (HCWs) to patients and vice versa, post-exposure prophylaxis, has become routine following the occupational exposure of HCWs to HIV. MethodsFocused ethnography was used to guide the data collection and in-depth interviews were used to collect the data between October and November 2009. ResultsSixteen nurses from a variety of units in a large teaching hospital participated. Needle-stick injuries were a fairly common occurrence, but written policies were frequently inaccessible to nurses and they did not have adequate knowledge of PEP. Some nurses were reluctant to report injuries and avoided following PEP procedures due to lack of knowledge about PEP, concerns about anti-retroviral side effects and the stigma associated with PEP. Participants were aware of PEP however there was a wide variation in their understanding of the procedure to follow after a needle-stick injury. ConclusionEmployers have a responsibility to update PEP guidelines and to orientate HCWs to these. Educators must ensure that undergraduate nurses have a comprehensive understanding of universal precautions and current practice for PEP.

Antiretroviral Toxicity Leading to a Medication Change in Multiple HIV Clinics in Resource Limited Settings

Background: Toxicities that led to antiretroviral substitution in a multi-country treatment program were described. Methods: First line regimens included stavudine, lamivudine and nevirapine or efavirenz. Alternative therapy included zidovudine, tenofovir, efavirenz and lopinavir/ritonavir. Clinicians were trained to diagnose common antiretroviral side effects. Facilities had access to safety laboratory assays. Toxicity was detected clinically, and confirmed or monitored using specific laboratory assays where indicated. Results: Between 2004 and 2006, among 6,520 patients in Uganda, Kenya and Zambia, initiating antiretroviral therapy, toxicity-related substitutions were observed for stavudine 24.6%, zidovudine 13%, nevirapine 6.6%, efavirenz 3.4%, lopinavir/ritonavir 2% and tenofovir 0.7%. Mean time to switch ranged from 25 days for Lopinavir/ ritonavir, to 141 days for stavudine. Most common toxicities included neuropathy (stavudine), anemia (zidovudine), rash and liver toxicity (nevirapine). Conclusions: Toxicity rates in the study were comparable to reports in Food and Drug Administration (FDA) label package inserts and other smaller published reports in Africa and Asia. These toxicity rates could be used to inform drug forecasting for resource-limited settings. Comparably high tolerability of tenofovir and efavirenz may support their preferential use.

Human immunodeficiency virus disease management in highly active antiretroviral therapy era: A comprehensive review

Human immunodeficiency virus (HIV) is a retrovirus belonging to the family Lentiviruses, which are responsible for chronic and long-lasting infections including the simian immunodeficiency virus (SIV) in monkeys. Since 1981, when the first acquired immunodeficiency syndrome (AIDS) cases were reported, HIV poses a challenge to human beings, and the UNAIDS global estimate reveals that currently more than 33.2 million people are living with HIV infection worldwide. HIV infection leads to variable disease course in different people. The biological basis of this variability in the disease progression is still unknown. Initiation of highly active antiretroviral therapy (HAART) although reduced the mortality, morbidity arising from antiretroviral side effects was a cause of concern. HIV-infected patient care has now shifted from complications arising from opportunistic infections to other causes attributable to HIV pathogenesis and toxic effects of HAART. Monitoring the disease progression and the response to HAART is traditionally carried out using TCD4+ cell counts and HIV/RNA viral load. Many clinical and laboratory markers have been used to estimate disease progression in HIV1 infection. HIV/AIDS after introduction of HAART has taken a different course where people infected with HIV have been considerably living longer due to reduced incidence of opportunistic infections and other AIDS-related conditions. HIV patient care should be multifaceted involving specialist HIV primary care physicians, infectious disease specialists, and emergency physicians considering the ways by which HIV and HAART have changed treatment and management of HIV-infected individuals.

Attitudes and practices of caregivers on adherence to antiretroviral (ARV) Drugs among HIV-Infected children attending comprehensive care clinic in Kenyatta National Hospital

Background: Ensuring high level of adherence to anti-retroviral medication (ARV) is a priority in treating people living with HIV and AIDS. Adherence in children cannot be fully studied if we do not recognize the involvement of primary caregivers who largely determine how well and often the ARV medication is taken. Objective: To determine attitude and practices of the primary caregivers on adherence of ARV in HIV+ve children. Methods: A cross-sectional study involving primary caregivers of HIV +ve children. Interviewer administered questionnaires were used to collect data from 126 primary caregivers. The data was complemented with key informant in-depth interviews with the health workers at the Comprehensive Care Centre (CCC) and two focus group discussions (FGD) of the primary caregivers. Setting: Kenyatta National Hospital comprehensive care centre for HIV/AIDS. Results: Adherence of 97.2 % to antiretroviral drugs was reported. The primary caregivers reported various methods they used to remind them when to give the medication e.g. clock alarms. 99.2% of the caregivers were aware of the ARV side effects. Out of the 126 caregivers interviewed, 96% of them recommended that caregivers of HIV+ve children should know their HIV Status. Conclusion: This study has revealed that practices and attitude of the caregivers of HIV +ve primary caregivers of HIV+ve children influence the ARV adherence levels. Primary care givers are susceptible to or do suffer stress and HIV/AIDs Comprehensive Care Centres should consider establishment of pychosocial support groups. More studies and follow up especially in the rural settings for comparison with urban areas are recommended. Keywords: antiretroviral treatment, children, primary caregivers, adherence Afr J Health Sci . 2013; 26:330-337