Clinical toxicity of highly active antiretroviral therapy in a home-based AIDS care program in rural Uganda.
BACKGROUND
We evaluated clinical toxicity in HIV-infected persons receiving antiretroviral therapy (ART) in Uganda.


METHODS
From May 2003 through December 2004, adults with a CD4 cell count < or =250 cells/microL or World Health Organization stage 3/4 HIV disease were prescribed ART. We calculated probabilities for time to toxicity and single-drug substitution as well as multivariate-adjusted hazard ratios for development of toxicity.


RESULTS
ART (stavudine plus lamivudine with nevirapine [96%] or efavirenz [4%]) was prescribed for 1029 adults, contributing 11,268 person-months of observation. Toxicities developed in 543 instances in 411 (40%) patients (incidence rate = 4.47/100 person-months): 36% peripheral neuropathy (9% severe); 6% rash (2% severe); 2% hypersensitivity reaction; < or =0.5% acute hepatitis, anemia, acute pancreatitis, or lactic acidosis; and 13% other. Probabilities of remaining free from any toxicity at 6, 12, and 18 months were 0.76, 0.59, and 0.47 and from any severe toxicity at 6, 12, and 18 months were 0.92, 0.86, and 0.85, respectively. For 217 patients (21%), 222 single-drug substitutions were made, mostly because of peripheral neuropathy or rash.


CONCLUSIONS
Clinical toxicities were common, but no patients discontinued ART because of toxicity. The most common toxicities, peripheral neuropathy and rash, were managed with single-drug substitutions. In resource-limited settings, toxicity from ART regimens containing stavudine or nevirapine is manageable but more tolerable regimens are needed.
Forna
Fatu
F
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. fforna@cdc.gov
Liechty
Cheryl A
CA
Solberg
Peter
P
Asiimwe
Fred
F
Were
Willy
W
Mermin
Jonathan
J
Behumbiize
Prosper
P
Tong
Tony
T
Brooks
John T
JT
Weidle
Paul J
PJ
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D000368:Aged; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000706:statistics & numerical data; D048588:Benzoxazines / Q000009:adverse effects / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003521:Cyclopropanes; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use; D010195:Pancreatitis / Q000139:chemically induced; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D016016:Proportional Hazards Models; D012423:Rural Health / Q000706:statistics & numerical data*; D018119:Stavudine / Q000009:adverse effects / Q000627:therapeutic use; D016019:Survival Analysis; D014454:Uganda
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine; C098320:efavirenz