Evaluation of antiretroviral therapy results in a resource‐poor setting in Blantyre, Malawi

• Published in: Tropical medicine & international health Vol. 10; no. 5; pp. 464 - 470
• Main Authors: Van Oosterhout, Joep J., Bodasing, Neena, Kumwenda, Johnstone J., Nyirenda, Cooper, Mallewa, Jane, Cleary, Paul R., De Baar, Michel P., Schuurman, Rob, Burger, David M., Zijlstra, Eduard E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.05.2005; Blackwell Science; Blackwell Publishing Ltd
• Subjects: adherence; Adolescent; Adult; Anti-HIV Agents - blood; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; antiretroviral; Biological and medical sciences; CD4 Lymphocyte Count - methods; Clinical outcomes; Cross-Sectional Studies; Drug therapy; Drug Therapy, Combination; Fees and Charges; Female; General aspects; Health services utilization; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Lamivudine - adverse effects; Lamivudine - economics; Lamivudine - therapeutic use; Malawi; Malawi - epidemiology; Male; Medical sciences; Middle Aged; nevirapine; Nevirapine - adverse effects; Nevirapine - economics; Nevirapine - therapeutic use; Patient Compliance; Stavudine - adverse effects; Stavudine - economics; Stavudine - therapeutic use; Treatment Failure; Treatment Outcome; Viral Load; Malawi; Africa; Human; Evaluation; RNA-directed DNA polymerase; Nevirapine; Enzyme; Non nucleoside compound; Transferases; adherence; Enzyme inhibitor; Drug compliance; antiretroviral; Nucleotidyltransferases; Chemotherapy; Treatment; HIV; Malawi; Reverse transcriptase inhibitor; Antiviral; Tropical medicine
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2005.01409.x

Summary Objective  To evaluate treatment results of the paying antiretroviral therapy (ART) clinic of Queen Elizabeth Central Hospital, a large public and teaching hospital in Blantyre, Malawi. The only ART was a fixed drug combination of stavudine, lamivudine and nevirapine. Methods  Cross sectional study with interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. Results  A total of 422 (59%) of the patients who started ART since 2000 were lost to follow‐up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non‐adherence were shortage of drugs in the hospital pharmacy and personal financial constraints. Conclusions  (1) Many patients were lost to follow‐up. (2) High nevirapine levels contributed to good therapy results in those studied. (3) Simple adherence questions predicted subtherapeutic nevirapine levels. (4) Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non‐adherence.