Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals
Identifieur interne : 002345 ( Pmc/Curation ); précédent : 002344; suivant : 002346Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals
Auteurs : Esayas Kebede Gudina ; Alula M. Teklu ; Asres Berhan ; Atsbeha Gebreegziabhier ; Teshome Seyoum ; Abiy Nega ; Girmay Medhin ; Amha Kebede ; Yibeltal AssefaSource :
- Ethiopian Journal of Health Sciences [ 1029-1857 ] ; 2017.
Abstract
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.
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.
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.
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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PubMed: 28465652
PubMed Central: 5402801
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Esayas Kebede Gudina<affiliation><nlm:aff id="A1">Department of Internal Medicine, Jimma University, Jimma</nlm:aff><wicri:noCountry code="subfield">Jimma</wicri:noCountry></affiliation><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A3">Department of Pharmacology, Hawassa University, Hawassa</nlm:aff><wicri:noCountry code="subfield">Hawassa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A5">Department of Internal Medicine, Hiwot Fana Hospital, Harar</nlm:aff><wicri:noCountry code="subfield">Harar</wicri:noCountry></affiliation><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A6">Aklilu Lemma Institute of Pathobiology, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation>Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals</title><author><name sortKey="Gudina, Esayas Kebede" sort="Gudina, Esayas Kebede" uniqKey="Gudina E" first="Esayas Kebede" last="Gudina">Esayas Kebede Gudina</name><affiliation><nlm:aff id="A1">Department of Internal Medicine, Jimma University, Jimma</nlm:aff><wicri:noCountry code="subfield">Jimma</wicri:noCountry></affiliation></author><author><name sortKey="Teklu, Alula M" sort="Teklu, Alula M" uniqKey="Teklu A" first="Alula M" last="Teklu">Alula M. Teklu</name><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation></author><author><name sortKey="Berhan, Asres" sort="Berhan, Asres" uniqKey="Berhan A" first="Asres" last="Berhan">Asres Berhan</name><affiliation><nlm:aff id="A3">Department of Pharmacology, Hawassa University, Hawassa</nlm:aff><wicri:noCountry code="subfield">Hawassa</wicri:noCountry></affiliation></author><author><name sortKey="Gebreegziabhier, Atsbeha" sort="Gebreegziabhier, Atsbeha" uniqKey="Gebreegziabhier A" first="Atsbeha" last="Gebreegziabhier">Atsbeha Gebreegziabhier</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Seyoum, Teshome" sort="Seyoum, Teshome" uniqKey="Seyoum T" first="Teshome" last="Seyoum">Teshome Seyoum</name><affiliation><nlm:aff id="A5">Department of Internal Medicine, Hiwot Fana Hospital, Harar</nlm:aff><wicri:noCountry code="subfield">Harar</wicri:noCountry></affiliation></author><author><name sortKey="Nega, Abiy" sort="Nega, Abiy" uniqKey="Nega A" first="Abiy" last="Nega">Abiy Nega</name><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation></author><author><name sortKey="Medhin, Girmay" sort="Medhin, Girmay" uniqKey="Medhin G" first="Girmay" last="Medhin">Girmay Medhin</name><affiliation><nlm:aff id="A6">Aklilu Lemma Institute of Pathobiology, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Kebede, Amha" sort="Kebede, Amha" uniqKey="Kebede A" first="Amha" last="Kebede">Amha Kebede</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Assefa, Yibeltal" sort="Assefa, Yibeltal" uniqKey="Assefa Y" first="Yibeltal" last="Assefa">Yibeltal Assefa</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28465652</idno><idno type="pmc">5402801</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402801</idno><idno type="RBID">PMC:5402801</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002346</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002346</idno><idno type="wicri:Area/Pmc/Curation">002345</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002345</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals</title><author><name sortKey="Gudina, Esayas Kebede" sort="Gudina, Esayas Kebede" uniqKey="Gudina E" first="Esayas Kebede" last="Gudina">Esayas Kebede Gudina</name><affiliation><nlm:aff id="A1">Department of Internal Medicine, Jimma University, Jimma</nlm:aff><wicri:noCountry code="subfield">Jimma</wicri:noCountry></affiliation></author><author><name sortKey="Teklu, Alula M" sort="Teklu, Alula M" uniqKey="Teklu A" first="Alula M" last="Teklu">Alula M. Teklu</name><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation></author><author><name sortKey="Berhan, Asres" sort="Berhan, Asres" uniqKey="Berhan A" first="Asres" last="Berhan">Asres Berhan</name><affiliation><nlm:aff id="A3">Department of Pharmacology, Hawassa University, Hawassa</nlm:aff><wicri:noCountry code="subfield">Hawassa</wicri:noCountry></affiliation></author><author><name sortKey="Gebreegziabhier, Atsbeha" sort="Gebreegziabhier, Atsbeha" uniqKey="Gebreegziabhier A" first="Atsbeha" last="Gebreegziabhier">Atsbeha Gebreegziabhier</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Seyoum, Teshome" sort="Seyoum, Teshome" uniqKey="Seyoum T" first="Teshome" last="Seyoum">Teshome Seyoum</name><affiliation><nlm:aff id="A5">Department of Internal Medicine, Hiwot Fana Hospital, Harar</nlm:aff><wicri:noCountry code="subfield">Harar</wicri:noCountry></affiliation></author><author><name sortKey="Nega, Abiy" sort="Nega, Abiy" uniqKey="Nega A" first="Abiy" last="Nega">Abiy Nega</name><affiliation><nlm:aff id="A2">MERQ Consultancy Services, Addis Ababa, Ethiopa</nlm:aff><wicri:noCountry code="subfield">Ethiopa</wicri:noCountry></affiliation></author><author><name sortKey="Medhin, Girmay" sort="Medhin, Girmay" uniqKey="Medhin G" first="Girmay" last="Medhin">Girmay Medhin</name><affiliation><nlm:aff id="A6">Aklilu Lemma Institute of Pathobiology, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Kebede, Amha" sort="Kebede, Amha" uniqKey="Kebede A" first="Amha" last="Kebede">Amha Kebede</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author><author><name sortKey="Assefa, Yibeltal" sort="Assefa, Yibeltal" uniqKey="Assefa Y" first="Yibeltal" last="Assefa">Yibeltal Assefa</name><affiliation><nlm:aff id="A4">Ethiopian Public Health Institute, Addis Ababa</nlm:aff><wicri:noCountry code="subfield">Addis Ababa</wicri:noCountry></affiliation></author></analytic><series><title level="j">Ethiopian Journal of Health Sciences</title><idno type="ISSN">1029-1857</idno><idno type="eISSN">2413-7170</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec sec-type="methods"><title>Methods</title><p>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.</p></sec><sec sec-type="results"><title>Result</title><p>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.</p></sec><sec sec-type="conclusions"><title>Conclusion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Dixon, S" uniqKey="Dixon S">S Dixon</name></author><author><name sortKey="Mcdonald, S" uniqKey="Mcdonald S">S McDonald</name></author><author><name sortKey="Roberts, J" uniqKey="Roberts J">J Roberts</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mwagomba, B" uniqKey="Mwagomba B">B Mwagomba</name></author><author><name sortKey="Zachariah, R" uniqKey="Zachariah R">R Zachariah</name></author><author><name sortKey="Massaquoi, M" uniqKey="Massaquoi M">M Massaquoi</name></author><author><name sortKey="Misindi, D" uniqKey="Misindi D">D Misindi</name></author><author><name sortKey="Manzi, M" uniqKey="Manzi M">M Manzi</name></author><author><name sortKey="Mandere, Bc" uniqKey="Mandere B">BC 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ethiop J Health Sci</journal-id><journal-id journal-id-type="iso-abbrev">Ethiop J Health Sci</journal-id><journal-title-group><journal-title>Ethiopian Journal of Health Sciences</journal-title></journal-title-group><issn pub-type="ppub">1029-1857</issn><issn pub-type="epub">2413-7170</issn><publisher><publisher-name>Research and Publications Office of Jimma University</publisher-name><publisher-loc>Jimma, Ethiopia</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28465652</article-id><article-id pub-id-type="pmc">5402801</article-id><article-id pub-id-type="publisher-id">jEJHS.v27.iS1.pg39</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia: A cohort study at seven teaching hospitals</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gudina</surname><given-names>Esayas Kebede</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Teklu</surname><given-names>Alula M</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Berhan</surname><given-names>Asres</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Gebreegziabhier</surname><given-names>Atsbeha</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Seyoum</surname><given-names>Teshome</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Nega</surname><given-names>Abiy</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Medhin</surname><given-names>Girmay</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Kebede</surname><given-names>Amha</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Assefa</surname><given-names>Yibeltal</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Internal Medicine, Jimma University, Jimma</aff><aff id="A2"><label>2</label>MERQ Consultancy Services, Addis Ababa, Ethiopa</aff><aff id="A3"><label>3</label>Department of Pharmacology, Hawassa University, Hawassa</aff><aff id="A4"><label>4</label>Ethiopian Public Health Institute, Addis Ababa</aff><aff id="A5"><label>5</label>Department of Internal Medicine, Hiwot Fana Hospital, Harar</aff><aff id="A6"><label>6</label>Aklilu Lemma Institute of Pathobiology, Addis Ababa</aff><author-notes><fn fn-type="financial-disclosure"><p><bold>Funding</bold>: Center for Disease Control and Prevention (CDC)</p></fn><fn fn-type="other"><p><bold>Competing Interests:</bold> The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists.</p></fn><corresp>*Esayas Kebede Gudina, <email>esakgd@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2017</year></pub-date><volume>27</volume><issue>Suppl 1</issue><fpage>39</fpage><lpage>52</lpage><history><date date-type="received"><day>1</day><month>2</month><year>2016</year></date><date date-type="accepted"><day>12</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © Jimma University, Research & Publications Office 2017</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract abstract-type="executive-summary"><sec><title>Background</title><p>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.</p></sec><sec sec-type="methods"><title>Methods</title><p>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.</p></sec><sec sec-type="results"><title>Result</title><p>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.</p></sec><sec sec-type="conclusions"><title>Conclusion</title><p>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.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>ART</kwd><kwd>adverse drug reaction</kwd><kwd>incidence rate</kwd><kwd>ACM</kwd><kwd>Ethiopia</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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