Evaluation of antiretroviral therapy results in Blantyre, Malawi

J J van Oosterhout; N Bodasing; J J Kumwenda; C Nyirenda; J Mallewa; P R Cleary; M P de Baar; R Schuurman; D M Burger; E E Zijlstra

doi:10.4314/mmj.v17i4.10892

Evaluation of antiretroviral therapy results in Blantyre, Malawi

Malawi Med J. 2005 Dec;17(4):112-6. doi: 10.4314/mmj.v17i4.10892.

Authors

J J van Oosterhout¹, N Bodasing¹, J J Kumwenda¹, C Nyirenda², J Mallewa², P R Cleary³, M P de Baar⁴, R Schuurman⁵, D M Burger⁶, E E Zijlstra¹

Affiliations

¹ Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
² Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Queen Elizabeth Central Hospital, Department of Medicine, Blantyre, Malawi.
³ Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi.
⁴ Primagen, Amsterdam, the Netherlands.
⁵ Department of Virology, University Medical Centre Utrecht, the Netherlands.
⁶ Department of Clinical Pharmacy, University Medical Centre Nijmegen, the Netherlands.

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.