HAART THERAPY IN GHANA: COMPARATIVE ASSESSMENT OF THE EFFECTIVENESS OF DIFFERENT HAART COMBINATIONS AT KOMFO ANOKYE TEACHING HOSPITAL

  • PAA KOFI TAWIAH ADU GYAMFI Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Department of Nursing and Midwifery, Faculty of Health and Allied Sciences, Pentecost University, Accra, Ghana
  • KWESI BOADU MENSAH Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • STEPHEN MENSAH ARHIN Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • ALIU MOOMIN Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Abstract

Objective: Although all marketed antiretrovirals (ARVs) have proven efficacy, genetic differences can result in varied effectiveness. This study was conducted to determine the effectiveness of different Highly Active Antiretroviral Therapy (HAART) combinations among patients attending HIV clinic at a Major Teaching Hospital in Ghana.


Methods: The study was a retrospective study involving 500 patients at an HIV clinic in the Ashanti Region of Ghana.


Results: Twelve major antiretroviral combinations for HAART were prescribed at the study center. The most prescribed drug combinations were AZT+3TC+EFV and AZT+3TC+NVP. The study identified that HAART, irrespective of the kind of drug combination used, was effective at increasing CD4 count within the first 6 mo of therapy initiation in the study population. However, the magnitude of the increases differed from combination to combination. All HAART combinations with zidovudine as one of the drugs resulted in higher CD4 counts compared with combinations containing stavudine. HAART with nevirapine also resulted in a higher CD4 count than those with efavirenz. However, efavirenz-based combinations appeared to be more effective in critically ill patients and patients with mean CD4+T helper cells count below 100 cell/mm3. More importantly, efavirenz was common among all HAART combinations that resulted in treatment failure.


Conclusion: There was significant variation in response to different HAART combination among Ghanaian HIV patients. However, there was no statistically significant difference in mean CD4 count between the two most predominately used HAART i. e AZT+3TC+EFV and AZT+3TC+NVP.

Keywords: Haart, AIDS, HIV, Antiretrovirals, Effectiveness, Sub-Sahara Africa

Downloads

Download data is not yet available.

References

1. Zhang F, Dou Z, Yu L, Xu J, Jiao JH, Wang N, et al. The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China. Clin Infectious Diseases 2008;47:825-33.
2. Nsagha DS, Weledji EP, Assob NJ, Njunda LA, Tanue EA, Ayima CW, et al. Highly active antiretroviral therapy and dyslipidemia in people living with HIV/AIDS in Fako Division, South West Region of Cameroon. BMC Cardiovascular Disorders 2015;15:95.
3. Bennett DE, Bertagnolio S, Sutherland D, Gilks CF. The world health organization's global strategy for the prevention and assessment of HIV drug resistance. Antiviral Therapy 2008;Suppl 2:1-13.
4. Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P, et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 2006;367:817-24.
5. Ma Q, Lu AY. Pharmacogenetics, pharmacogenomics, and individualized medicine. Pharmacol Rev 2011;63:437-59.
6. Tozzi V. Pharmacogenetics of antiretrovirals. Antiviral Res 2010;85:190-200.
7. Ingelman Sundberg M, Sim SC, Gomez A, Rodriguez Antona C. Influence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects. Pharmacol Ther 2007;116:496-526.
8. Pavlos R, Phillips EJ. Individualization of antiretroviral therapy. Pharmacogenomics Pers Med 2012;5:1.
9. Alfonso V, Bermbach N, Geller J, Montaner JS. Individual variability in barriers affecting people's decision to take HAART: a qualitative study identifying barriers to being on HAART. AIDS Patient Care STDs 2006;20:848-57.
10. Mensah KB, Adu Gyamfi PK, Boakye Gyasi E. HAART therapy in ghana: assessment of adverse drug reaction reports of patients at an HIV clinic and a teaching hospital. J Basic Clin Pharm 2017;8:1.
11. Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci 2006;1:9-14.
12. Ghana Statistical Service. 2010 population and housing census report. Ghana Statistical Service; 2014.
13. Sandeep B, Chavan VR, Raghunandan M, Arshad M, Sayana SB. Factors influencing the substitution of antiretroviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome patients on first-line highly active antiretroviral therapy. Asian J Pharm Clin Res 2014;7:117-20.
14. Obeng RK. Prevalence and causes of antiretroviral treatment failure among adults receiving therapy at Komfo Anokye teaching hospital (Doctoral dissertation); 2010.
15. World Health Organization. Antiretroviral therapy of HIV infection in infants and children: towards universal access: recommendations for a public health approach-2010 revision. World Health Organization; 2010.
16. Kr D, Sanji N, Aggarwal V, Sr R, Hs S. Changes in the CD4 counts, hemoglobin and weight in patients with HIV alone and HIV-TB co-infection. Asian J Pharm Clin Res 2014;7:35-8.
17. Mayer KH, Cooney EL. Clinical indicators of immune restoration following highly active antiretroviral therapy. Clin Infectious Diseases 2002;34:224-33.
18. Insight Start Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England J Med 2015;373:795-807.
19. Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, et al. Early antiretroviral therapy and mortality among HIV-infected infants. New England J Med 2008;359:2233-44.
20. Barasa SS. True story about HIV: theory of viral sequestration and reserve infection. HIV/AIDS (Auckland, NZ) 2011;3:125.
21. Ferradini L, Jeannin A, Pinoges L, Izopet J, Odhiambo D, Mankhambo L, et al. Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment. Lancet 2006;367:1335-42.
22. Lawn SD, Myer L, Orrell C, Bekker LG, Wood R. Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design. AIDS 2005;19:2141-8.
23. Bonnet F, Thiebaut R, Chene G, Neau D, Pellegrin JL, Mercie P, et al. Determinants of clinical progression in antiretroviral?naïve HIV?infected patients starting highly active antiretroviral therapy. Aquitaine Cohort France 1996–2002. HIV Med 2005;6:198-205.
24. Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002;360:119-29.
25. Pillay P, Ford N, Shubber Z, Ferrand RA. Outcomes for efavirenz versus nevirapine-containing regimens for treatment of HIV-1 infection: a systematic review and meta-analysis. PloS One 2013;8:e68995.
26. Van Oosterhout JJ, Bodasing N, Kumwenda JJ, Nyirenda C, Mallewa J, Cleary PR, et al. Evaluation of antiretroviral therapy results in a resource?poor setting in Blantyre, Malawi. Trop Med Int Health 2005;10:464-70.
27. Shet A, Antony J, Arumugam K, Dodderi SK, Rodrigues R, DeCosta A. Influence of adverse drug reactions on treatment success: a prospective cohort analysis of HIV-infected individuals initiating first-line antiretroviral therapy in India. PLOS ONE 2014;9:e91028.
28. Murphy EL, Collier AC, Kalish LA, Assmann SF, Para MF, Flanigan TP, et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Annals Internal Med 2001;135:17-26.
29. Hart E, Curtis H, Wilkins E, Johnson M. National review of first treatment change after starting highly active antiretroviral therapy in antiretroviral?naïve patients. HIV Med 2007;8:186-91.
Statistics
18 Views | 0 Downloads
Citatons
How to Cite
GYAMFI, P. K. T. A., K. B. MENSAH, S. M. ARHIN, and A. MOOMIN. “HAART THERAPY IN GHANA: COMPARATIVE ASSESSMENT OF THE EFFECTIVENESS OF DIFFERENT HAART COMBINATIONS AT KOMFO ANOKYE TEACHING HOSPITAL”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 12, no. 3, Feb. 2020, pp. 89-93, doi:10.22159/ijpps.2020v12i3.36567.
Section
Original Article(s)