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Antiretroviral Therapy-associated Adverse Drug Reactions and their Effects on Virologic Failure- A Retrospective Cohort Study in Nigeria

[ Vol. 16 , Issue. 6 ]


Isaac O. Abah*, Nondumiso B.Q. Ncube, Hazel A. Bradley, Oche O. AgbaJi and Phyllis Kanki   Pages 436 - 446 ( 11 )


Background: Adverse drug reactions (ADRs) associated with antiretroviral therapy (ART) can rapidly reverse the gains of ART resulting in poor health outcomes. We need an improved understanding of specific ART-related ADRs that influence virologic outcomes.

Objective: To investigate the frequency of clinical ADRs and assess their effect on virologic failure in patients on ART.

Method: We described the prevalence of major clinical ADRs, and the association between specific ADRs and virologic failure in a clinic cohort of HIV-1 infected Nigerians aged ≥18 years, on firstline ART between June 2004 and February 2012. Multivariable logistic regression was run to identify predictors of virologic failure at 24 and 72 weeks of ART.

Results: Data of 12,115 patients with a median age of 34 (interquartile range: 29-41) years, and predominantly females (67%) were evaluated. Overall, 957 (7.9%) patients experienced at least one ADR during a median follow-up period of 4 years (interquartile range: 1-7). The three most prevalent ADRs were lipodystrophy (2.6%), anemia (1.9%), and skin rash (0.7%). Virologic failure rate was 36% and 34% at 24 and 72 weeks of ART, respectively. Anemia independently predicted the odds of virologic failure at 72 weeks of ART (adjusted odds ratio, 1.74; 95% CI: 1.2-2.51); adjusted for sex, age, pre-treatment CD4+ cell count, antiretroviral regimen, and medication refill adherence.

Conclusion: Antiretroviral therapy-associated anemia increases the likelihood of late virologic failure. We recommend routine monitoring of hemoglobin levels and prompt management of anemia in all patients on ART as a strategy to improve virologic success rates.


Adverse drug reaction, antiretroviral therapy, anemia, toxicity, treatment failure, viral suppression.


School of Public Health, University of the Western Cape, Bellville, School of Public Health, University of the Western Cape, Bellville, School of Public Health, University of the Western Cape, Bellville, Department of Medicine Jos University Teaching Hospital/University of Jos, Jos, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

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