Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi.
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.
van Oosterhout
Joep J
JJ
Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. vanoosterhout@malawi.net
Bodasing
Neena
N
Kumwenda
Johnstone J
JJ
Nyirenda
Cooper
C
Mallewa
Jane
J
Cleary
Paul R
PR
de Baar
Michel P
MP
Schuurman
Rob
R
Burger
David M
DM
Zijlstra
Eduard E
EE
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
D019380:Anti-HIV Agents; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine