PHARMACOTHERAPEUTIC STUDY OF ANTIRETROVIRAL THERAPY FOR HIV/AIDS PATIENTS AT THE FEDERAL MEDICAL CENTRE, OWO, ONDO STATE, NIGERIA

Authors

Isiaka Adebowale Ayeni Pharm., Department of Pharmaceutical Services, Federal Medical Centre, Owo, NigeriaFollow
Adelanwa Oludele Itiola Prof, Department of Pharmaceutics, Faculty of Pharmacy, University of Ibadan, Nigeria.Follow
Tajudeen Temitayo Adebayo Dr., Department of Health Information Management, Federal Medical Centre, Owo, Ondo State, Nigeria.Follow

Document Type

Article

Citation

Adeyi O, Kanki PJ, Odutolu O, et al ‘AIDS in Nigeria: A nation on the threshold’. The epidemiology of HIV/AIDS in Nigeria. Harvard Center for Population and Development Studies. 2006:67-69

Akinola NO, Olasode O, Adediran I A, et al. The search for a predictor of CD4 cell count continues: total lmyphocyte count is not a substitute for CD4 cell count in the management of HIV-infected individuals in resource-limited settings. Clinical Infectious Diseases 2004; 39:579-581.

Bamgboye E. A. Textbook of Medical Statistics. 1st ed. Ibadan: Ibipress, 2006, P 116,120.

Beck, EJ, Mandalia S, Gaudreault M, et al. The cost effectiveness of highly active antiretroviral therapy, Canada 1991 – 2001. AIDS 2004; 18:2411-2418.

Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolelescents: Guidelines for the use of Antiretroviral Agents in HIV-1- infected Adults and Adolescents (2008). Department of Health and Human Services, www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf. Accessed 12 October 2009.

Detels R, Munoz A, McFarlane G, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicentre AIDS Cohort study investigators. JAMA 1998; 280(35): 17-26.

Egger M, May M, Chêne G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360(9327):119-129.

F van Leth, P, Phanuphak, K Ruxrungtham et al (2004). Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz or both drugs, plus stavudine and lamivudine: a randomised open- label trial, the 2NN Study. The Lancet; 363(9417):1253-1263.

Fee E and Krieger N (1993). Understanding AIDS: historical interpretations and the limits of biomedical individualism. Am J Public Health; 83(10):1477-86.

Giordano TP, Wright JA, Hasan MQ. Do sex and race/ethnicity influence CD4 cell response in patients who achieve virologic suppression during antiretroviral therapy? Clin Infect Dis. 2003; 37:433-437.

Guatam H, P Bhalla, S Saini, et al. Correlation between baseline CD4⁺ T –lymphocyte count and plasma viral load in AIDS patients and their early clinical and immunological response to HAART: A preliminary study. Indian journal of medical microbiology 2008; 26(3):256-58.

Gulick RM, Ribaudo, H.J., Shikuma, CM, et al. Triple-nucleoside regimens versus efavirenz-containing regimens for the initial treatment of HIV-1 infection. N Engl J Med. 2004; 350(18):1850-61.

Haider SI, Johnell K, Weitoft GR, et al. The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people”. J Am Geriatr Soc. 2009; 57(1): 62-69.

Kaufmann GR, Perrin L, Pantaleo G, et al. CD4 T – lymphocyte recovery in individuals with advanced HIV – 1 infection receiving potent antiretroviral therapy for 4 years: the Swiss HIV Cohort study. Arch Intern Med 2003; 163 (18): 2187 –95.

Lavreys L, Baeten JM, Martin HL, et al. "Hormonal contraception and risk of HIV-1 acquisition: results of a 10-year prospective study". AIDS 2004; 18 (4): 695–7.

Manfredi R, Chiodo F. A case control study of virological and immunological effects of highly active antiretroviral therapy in HIV infected patients with advanced age. AIDS 2000; 14(10):1475-1477.

Mellors JW, Munoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997; 126(12):946-54.

Micheal E Burton, Leslie M Shaw, Jerome J Schentag, William E Evans (2006). Applied pharmacokinetics and pharmacodynamics: Principles of Therapeutic Drug Monitoring. In: Craig R Rayner, Micheal J Dooley and Roger L Nation (eds). Antivirals for HIV. 4^th ed. Maryland: Lippincott Williams & Wilkins, pp354.

Murphy EL, Collier AC, Kalish LA, et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern med 2001; 135(1):17-26.

Nigerian National Guidelines on the use of Antiretroviral Drugs. FMOH Abuja, 2005.

O’Brien ME, Clark RA, Besch CL, et al. Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort. J. Acquir Immune Defic Syndr 2003; 34(4): 407 -14.

Palella FJ, Delanney KM, Moorman AC et al, (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med; 338:853-60.

Palmisano L, Vella S (2001). A brief history of antiretroviral therapy of HIV infection: Success and challenges. Ann Ist Super Sanita; 47(1):44-48.

Paul Collini, Uli Schwab, Stephen Sarfo, et al. Sustained Immunological Response to Highly Active Antiretroviral Therapy at 36 months in a Ghanaian HIV cohort. Clinical Infectious Diseases 2009; 48(7):988-91.

Piscitelli SC & Gallicano KD (2001). Interactions among drugs for HIV and opportunistic infections. N Eng J Med; 344(13):984-96.

Sepkowitz KA. AIDS – the first 20 years. N Engl J Med 2001; 344(23): 1764 –72.

Squires K, Lazzarin A, Gatell JM, et al. Comparison of once-daily atazanavir with efavirenz, each in combination with fixed-dose zidovudine and lamivudine, as Initial therapy for patients infected with HIV. J Acquir Immune Defic Syndr. 2004; 36(5):1011-9.

Staszewski S, Morales-Ramirez J, Tashima KT, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. N Engl J Med 1999; 341(25):1865-73.

Technical report on the 2001 National HIV/Syphilis Sentinel Survey among pregnant women attending antenatal clinics in Nigeria. National AIDS/STDs Control Programme. FMOH; Abuja, 2004.

Tony Antoniou & Alice Lin-in Tseng (2002). Interactions between Recreational Drugs and Antiretroviral Agents. Annals of Pharmacotherapy; 36(10):1598-1613.

UNAID 2008 Report on the global AIDS epidemic, http://www.unaids.org/en/knowledgecentre/HIVData/Globalreport.asp (2008, accessed 28 March 2009).

Weiss RA. How does HIV cause AIDS? Science 1993; 260 (5112): 1273 – 9

WHO Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults: recommendations for a public health approach, http://www.etharc.org/arcinfo/cotrimoxazoleguide.pdf (2006, accessed 11 May 2009).

World Health Organization, UNAIDS and UNICEF (2008) “Towards Universal access: Scaling up priority HIV/AIDS” interventions in the health sector, http://www.who.int/hiv/pub/2008progressreport/en/ (2008, accessed 28 March 2009).

World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach, http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf. accessed 12 October 2009.

World Health Organization. Interim proposal for a WHO staging system for HIV infection and disease. WHO Wkly Epidem. Rec. 1990. 65(29): 221 –228.

Young FE (1988). The role of the FDA in the effort against AIDS. Public Health Rep; 103(3):242-245.

Abstract

A 6-12 months retrospective study is made of HAART utilization in cases of HIV/AIDS patients at Federal Medical Centre, Owo, Nigeria. The objective to evaluate the rational pharmacotherapeutic approach to the management of the retroviral disease. Sixty two (62) antiretroviral drug-naive HIV/AIDS patients, which comprise of (19) 30.65% males with a mean age of 37.15±8.55 years and (43) 69.35% females with a mean age of 35.68±9.75 years case files are reviewed. The data used for this study was extracted from the clinical records of the Hospital. Sixty six percent of the patients are at World Health Organization (WHO) clinical stage III or IV of the HIV disease at initiation of HAART and 35.70% of patients have baseline CD4 cell count ≤50 cells/µL. Stavudine/Lamivudine/Nevirapine is used as HAART first line regimen in 87.10% of the patients while 12.90% are prescribed Stavudine/Lamivudine/Efavirenz due to underlying TB infection. Three (3) patients switched their initial regimen while a patient had her regimen discontinued because of drug adverse effects. Evaluation of 35 patients for therapeutic response after a mean period of 9.07 months shows that, in 82.86% of patients, mean CD4 cell count increased from 96.70 ± 67.90 cells/µL (median 104 cells/µL) at baseline to 267.60 ± 141 cells/µL (median 267 cells/µL). After a mean period of 9.07 months of HAART, there is a significant difference in the change in CD4 count among male and female patients there is no significant correlation between age and change in patients’ CD4 count and within female patients but there is a significant positive correlation between age and change in CD4 count within male patients. It is therefore concluded that rational use of HAART in patients with retroviral disease will lead to significant improvement in most patients’ immunological status and invariably quality of life.