Abah Isaac O, Ncube Nondumiso B Q, Bradley Hazel A, AgbaJi Oche O, Kanki Phyllis
School of Public Health, University of the Western Cape, Bellville, South Africa.
Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria.
Curr HIV Res. 2018;16(6):436-446. doi: 10.2174/1389450120666190214144609.
Adverse drug reactions (ADRs) associated with antiretroviral therapy (ART) can rapidly reverse the gains of ART resulting in poor health outcomes. We need an improved understanding of specific ART-related ADRs that influence virologic outcomes.
To investigate the frequency of clinical ADRs and assess their effect on virologic failure in patients on ART.
We described the prevalence of major clinical ADRs, and the association between specific ADRs and virologic failure in a clinic cohort of HIV-1 infected Nigerians aged ≥18 years, on firstline ART between June 2004 and February 2012. Multivariable logistic regression was run to identify predictors of virologic failure at 24 and 72 weeks of ART.
Data of 12,115 patients with a median age of 34 (interquartile range: 29-41) years, and predominantly females (67%) were evaluated. Overall, 957 (7.9%) patients experienced at least one ADR during a median follow-up period of 4 years (interquartile range: 1-7). The three most prevalent ADRs were lipodystrophy (2.6%), anemia (1.9%), and skin rash (0.7%). Virologic failure rate was 36% and 34% at 24 and 72 weeks of ART, respectively. Anemia independently predicted the odds of virologic failure at 72 weeks of ART (adjusted odds ratio, 1.74; 95% CI: 1.2-2.51); adjusted for sex, age, pre-treatment CD4+ cell count, antiretroviral regimen, and medication refill adherence.
Antiretroviral therapy-associated anemia increases the likelihood of late virologic failure. We recommend routine monitoring of hemoglobin levels and prompt management of anemia in all patients on ART as a strategy to improve virologic success rates.
与抗逆转录病毒疗法（ART）相关的药物不良反应（ADR）可迅速抵消ART所带来的益处，导致健康状况不佳。我们需要更好地了解影响病毒学结果的特定ART相关ADR。
调查临床ADR的发生率，并评估其对接受ART治疗患者病毒学失败的影响。
我们描述了2004年6月至2012年2月期间在尼日利亚≥18岁的HIV-1感染患者临床队列中，接受一线ART治疗时主要临床ADR的患病率，以及特定ADR与病毒学失败之间的关联。采用多变量逻辑回归分析来确定ART治疗24周和72周时病毒学失败的预测因素。
共评估了12115例患者的数据，中位年龄为34岁（四分位间距：29-41岁），女性占大多数（67%）。总体而言，在中位随访期4年（四分位间距：1-7年）内，957例（7.9%）患者至少经历了一次ADR。最常见的三种ADR分别是脂肪代谢障碍（2.6%）、贫血（1.9%）和皮疹（0.7%）。ART治疗24周和72周时的病毒学失败率分别为36%和34%。贫血是ART治疗72周时病毒学失败几率的独立预测因素（调整后的优势比为1.74；95%置信区间：1.2-2.51）；对性别、年龄、治疗前CD4+细胞计数、抗逆转录病毒治疗方案和药物补充依从性进行了调整。
抗逆转录病毒疗法相关的贫血会增加晚期病毒学失败的可能性。我们建议对所有接受ART治疗的患者常规监测血红蛋白水平，并及时处理贫血，以此作为提高病毒学成功率的策略。
