Suboptimal Antiretroviral Drug Levels and Virologic Failures among PLHIV at a Rural Referral Hospital in South Western Uganda: A Descriptive Crosssectional Study
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Achieving favorable HIV treatment outcomes is a major challenge, particularly due to nonadherence
and consequent sub-therapeutic plasma antiretroviral drug levels. This is often complicated by
the development of resistant strains due to mutations. Monitoring antiretroviral drug levels in the blood of
patients enrolled on ART can reveal if levels are too high, enough, or too low. High levels may lead to
dose-dependent side effects and sub-therapeutic levels could promote treatment failure and resistance. In
Uganda, as part of routine HIV care, plasma antiretroviral drug level is estimated indirectly by clinic-based
pill counts and patient self-reported adherence, which give no evidence of ingested medication. This
study aimed at exploring steady-state nevirapine and efavirenz drug levels in HIV patients accessing ART
at a rural referral hospital in South Western Uganda.
Methods: This study was nested into a randomized clinical trial that evaluated the effect of Artemisia
annua L. and Moringa oleifera on immunological response and viral load among persons living with HIV
(PLHIV). In the parent study, 250 HIV-infected patients with continued immunologic suppression (CD4
count < 350cells/μL) despite a minimum of one-year on ART were enrolled. Out of 250 clinical trial
participants, 95 were randomly selected for steady-state efavirenz and nevirapine plasma concentration
sampling having taken the last at bedtime. Additionally, CD4 count, HIV load, liver, and renal function
tests were determined. Participants were also interviewed for adherence, and factors that affect blood
drug levels.
Description
Keywords
Antiretroviral Drug Levels, Efavirenz, Nevirapine, Virologic Failures, Uganda
Citation
Twinomujuni, S. S., Ogwang, P. E., Roelofsen, F., Mukonzo, J. K., & Atukunda, E. C. (2020). Suboptimal Antiretroviral Drug Levels and Virologic Failures among PLHIV at a Rural Referral Hospital in South Western Uganda: A Descriptive Cross-sectional Study.https://doi.org/10.21203/rs.3.rs-122206/v1