Magnitude of Antiretroviral Drug Toxicity in Adult HIV Patients in Ethiopia A cohort study at seven teaching hospitals

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Esayas Kebede Gudina
Alula M. Teklu
Asres Berhan
Atsbeha Gebreegziabhier
Teshome Seyoum
Abiy Nega
Girmay Medhin
Amha Kebede , Yibeltal Assefa


Background: The introduction of antiretroviral therapy (ART) hasresulted in significant mortality reduction and improvement in thequality of life. However, this has come at a cost of increased drugtoxicity. The objective of this study was to assess the patterns andpredictors of ART toxicity in adult HIV patients in Ethiopia.Methods: This is a prospective cohort study conducted at seventeaching hospitals between September 2009 and December 2013involving 3921 HIV patients on ART. Adverse drug reactions(ADR) due to ART were identified based on clinical assessmentand/or laboratory parameters. Multivariable random effectsPoisson regression analysis was used to identify factorsindependently associated with toxicity.Result: ADR due to ART drugs was reported in 867 (22.1 %) of theparticipants; 374 (9.5%) had severe forms. About 87% of reportedtoxicities were limited to three organ systems – the skin, nervoussystem and blood. The overall incidence of ADR was 9 per 100person years. About a third of toxicities occurred during the firstsix months after ART initiation with the incidence rate of 22.4 per100 person years. Concomitant anti-tuberculosis treatment was thestrongest independent predictor of toxicity.Conclusion: ADR was found to be highly prevalent in HIV patientson ART at tertiary hospitals in Ethiopia. Most of these conditionsoccurred early after ART initiation and in those with concomitantanti-tuberculosis treatment. Thus, routine monitoring of patientson ART should be strengthened with particular emphasis in thefirst 6 months. Strategies should also be devised to replace olderand more toxic agents with newer and safer drugs available.

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Original Article
Author Biographies

Esayas Kebede Gudina, Jimma University, Jimma

Department of Internal Medicine

Alula M. Teklu, , AddisAbaba, Ethiopa

MERQ Consultancy Services

Asres Berhan, Hawassa University, Hawassa

Department of Pharmacology,

Atsbeha Gebreegziabhier, Addis Ababa

Ethiopian Public Health Institute

Teshome Seyoum, Hiwot Fana Hospital, Harar

Department of Internal Medicine

Abiy Nega, AddisAbaba, Ethiopa

MERQ Consultancy Services

Girmay Medhin, Addis Ababa

Aklilu Lemma Institute of Pathobiology,

Amha Kebede , Yibeltal Assefa, Addis Ababa

Ethiopian Public Health Institute

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