title: Evaluation of antiretroviral therapy results in Blantyre, Malawi.
abstract: We performed a cross sectional study to evaluate treatment results of the paying antiretroviral therapy clinic of Queen Elizabeth Central Hospital, Blantyre. The only antiretroviral therapy was a fixed drug combination of stavudine, lamivudine and nevirapine.
  
  
  METHODS
  Interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. 422 (59 %) of the patients who started antiretroviral therapy 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
  Many patients were lost to follow up.High nevirapine levels contributed to good therapy results in those studied.Simple adherence questions predicted sub-therapeutic nevirapine levels.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.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: N
authors.initials: N
authors.lastname: Bodasing
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kumwenda
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Queen Elizabeth Central Hospital, Department of Medicine, Blantyre, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Nyirenda
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Queen Elizabeth Central Hospital, Department of Medicine, Blantyre, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Mallewa
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: P R
authors.initials: PR
authors.lastname: Cleary
authors.affiliation: Primagen, Amsterdam, the Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: de Baar
authors.affiliation: Department of Virology, University Medical Centre Utrecht, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Schuurman
authors.affiliation: Department of Clinical Pharmacy, University Medical Centre Nijmegen, the Netherlands.
authors.forename: D M
authors.initials: DM
authors.lastname: Burger
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: E E
authors.initials: EE
authors.lastname: Zijlstra