A prospective study of highly active antiretroviral therapy in Indian human immunodeficiency virus positive patients

Article type: Research Article

Authors: Rajesh, Radhakrishnan | Vidyasagar, Sudha | Varma, Danturulu Muralidhar | Naik, Anand | Hegde, Brahmavar Mohandas | Guddattu, Vasudeva | Kamath, Asha

Affiliations: Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India | Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India | District Hospital, Udupi, Karnataka, India | ART Centre, District Hospital, Udupi, Karnataka, India | Department of Statistics, Manipal University, Manipal, Karnataka, India | Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal Karnataka, India

Note: [] Address for correspondence: Radhakrishnan Rajesh, Senior Grade Lecturer, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences and Kasturba Medical College Hospital, Manipal University, Manipal - 576 104, Karnataka, India. Tel.: +91 820 2922482; +91 9448374166; Fax: +91 820 2571998; E-mails: [email protected]; [email protected]

Abstract: BACKGROUND: There are no studies performed in India on the safety of highly active antiretroviral therapy (HAART) combinations which focus on the base-line CD4+ T-cell count. Further, no data on risk factors for Adverse drug reactions (ADRs) to HAART and there is a lack of data on CD4+ T-cell count recovery after HAART. OBJECTIVES: The aim of this study was to assess risk factors for ADRs to HAART. We also compared the efficacy of HAART combinations with respect to base-line CD4+ T-cell count and CD4+ T-cell counts recovery in Indian HIV positive patients. METHODS: A prospective active surveillance study was adopted at the Antiretroviral Therapy (ART) Centre, District Government Hospital, Udupi, India. HIV-infected patients were intensively monitored to identify risk factors associated with ADRs to HAART from August 2009 to May 2012. The study protocol was approved by the University ethics committee. Baseline CD4+ T-cell count before initiation of HAART and thereafter at every six months of regular follow-up up to 24 months duration was included for comparison. Multivariate logistic regression analysis was used to identify predictors of high risk factors of ADRs. CD4+ T-cell count recovery after HAART from base-line CD4+ T-cell count in different HAART groups was analyzed by test of between-subject effects. P-value <0.05 was considered as statistically significant. RESULTS: A total of 1982 HIV positive patients were enrolled with 1181 (59.6%) males, and 801 (40.4%) females. On multivariate logistic regression analysis, four factors were found to be predictors of high-risk factors for ADRs to HAART: 1) CD4+ T-cell counts, 2) female gender, 3) polypharmacy and 4) opportunistic infections. Between HAART groups, a mean increase of 98 cells/μl of CD4+ T-cell counts recovery was seen in the 3TC + NVP + D4T group (p < 0.001) at 24 months of regular follow-up. CONCLUSION: In India, Clinician should take into consideration all possible risk factors associated with the use of HAART in order to avoid and minimize ADRs. As initial CD4+ T-cell count and age of patient decides the rise of CD4+ T-cell counts with HAART. HAART should be initiated at the earliest age in order to attain maximum CD4+ T-cell counts recovery.

Keywords: Pharmacovigilance, highly active antiretroviral therapy, human immunodeficiency virus, adverse drug reaction, CD4$^+$ T-cell count

DOI: 10.3233/JRS-130580

Journal: International Journal of Risk & Safety in Medicine, vol. 25, no. 1, pp. 53-65, 2013