Risk factors, management and outcomes of adverse drug reactions in adult patients on antiretrovirals at Kenyatta National Hospital, Nairobi.
BACKGROUND
Antiretrovirals have been associated with serious adverse drug reactions. Several factors have been suggested as independent risk factors for their development. Identification of these factors may help in prevention and management of the adverse drug reactions.


OBJECTIVE
To describe the factors associated with adverse drug reactions, their management, and the clinical outcomes.


METHODS
A retrospective cohort study.


METHODS
Kenyatta National Hospital, Comprehensive Care Centre.


METHODS
Adult patients receiving antiretrovirals from 2003 to 2006.


METHODS
The primary outcomes were the risk-factors, interventions and outcomes of documented adverse drug reaction after exposure to antiretrovirals.


RESULTS
Systematic random sampling was used to pick 350 patients' files. The risk factors for experiencing at least one adverse drug reaction were: having a baseline CD4 count less than 123 (odds ratio [OR] = 1.82, 95% confidence interval [CI: 1.18 to 2.79; p = 0.006); treatment with antiretrovirals for more than 32 months (OR = 1.76, CI: 1.15 to 2.71; p = 0.010), using didanosine containing regimens (OR = 3.7, CI: 1.40 to 9.70; p = 0.008) or being on stavudine containing regimens (OR = 4.4, CI: 2.53 to 7.71; p = 0.001). The most common intervention was addition of a non-antiretroviral while 41% of events resulted in a change of anti-retroviral therapy.


CONCLUSIONS
Current standard regimens in resource-limited countries are associated with an increased risk of adverse drug reactions. Almost half of adverse reactions are managed by addition of a non-anti-retroviral drug alone but 41% necessitated a change of anti-retrovirals.
Department of Pharmaceutics and Pharmacy Practice, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
L E M
LE
Mwangangi
R
R
Juma
D K
DK
Scott
D G
DG
Nyamu
K A M
KA
Kuria
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors
D044966:Anti-Retroviral Agents