title: Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi.
abstract: 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.
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. vanoosterhout@malawi.net
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: Neena
authors.initials: N
authors.lastname: Bodasing
authors.forename: Johnstone J
authors.initials: JJ
authors.lastname: Kumwenda
authors.forename: Cooper
authors.initials: C
authors.lastname: Nyirenda
authors.forename: Jane
authors.initials: J
authors.lastname: Mallewa
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cleary
authors.forename: Michel P
authors.initials: MP
authors.lastname: de Baar
authors.forename: Rob
authors.initials: R
authors.lastname: Schuurman
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zijlstra
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood / Q000191:economics / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000379:methods; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005249:Fees and Charges; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D010349:Patient Compliance; D018119:Stavudine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine