The Antiretroviral drugs toxicity and immune status of HIV patients attending Runyenjes comprehensive care centre, Embu, Kenya
Namu, John Samuel
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Human Immune Deficiency Virus (HIV) has become a global problem which has reduced the quality and lifespan of many people allover the world The World Health Organization (WHO) has established that ARVs reduce the suffering of mv patients. Currently, there are various AR V regimes in use, and they are taken for a long period of time. This could lead to emergence of ARV associated toxicity. The objective of this study was to determine toxicity and immune status of mv patients under ARVs (Zidovudine, Stavudine and Nevirapine) which comprises first line ARV regime currently being used in this country. The study design was longitudinal, a case study involving mv patients attending Runyenjes comprehensive care centre (CCC) during the months of May to November 2009. A total of sixty mv patients participated in the study after consenting to undergo comprehensive care. A control group of 40 HIV patients on only contrimoxale (septrin), an antibiotic used to control opportunistic infections was also monitored for six months to exclude the compounding effects of accompanying antibiotics. Baseline values of creatinine and haemograms were determined and compared with immunological parameters for different levels of treatment monthly over a period of six months. CD3 and CD4 cell counts were determined in a Fluorescence Activated Cell sorter (F ACs) using cross reactive antibodies while mean corpuscular volumes. (MCV), platelets and Haemoglobin (Hb) were determined using a blood cell analyser, Using a serum analyser serum creatinine was determined and used as an indicator of toxicity of the ARV drugs. AnalYSIS of Variance (ANOVA), t-test and correlation coeficient were used to analyse the data. The results showed that out of sixty mv patients sampled twenty (33.3%) had baseline CD4 counts less than 50 cells ltd of blood, 9 (15%) between 50-100 cells/ul of blood, 8 (13.3%) between 101-150 cells/ul of blood and 23 (38.4%) above 150 cellslJllofblood. Correlation analysis showed that creatinine was weakly positively correlated with MCV (p<O.OI; r=O.149), weakly correlated with CD3 (p<0.01; r=O.063), weakly correlated to haemoglobin level (p<0.01; r=O.059), weakly correlated with platelet counts (p<0.01; r=O.082) and positively correlated to CD4 (p<O.Ol; r=O.178). Increase in creatinine levels resulted in increased CD4 and CD3 up to the third month and increased levels of haemoglobin, MCV and platelet up to the sixth month. Results also showed significant increase in mean creatinine following 6 months of ARV use (p<O.OI, F=22.73, df=5) and that treatment with ARV s may cause toxicity especially to patients with baseline CD4 counts of 50-100 cells/ul of blood by the sixth month of use. Results of the control group of patients showed no significant changes in mean creatinine (p=O.l, F==O.OO4, df=5) with a mean ofO.99mgldl of blood which was within normal creatinine range in health. The findings of this study will be useful in understanding the potency of ARV regime and associated toxicity. Based on the data observed in this study it is recommended that the AR V drug combination used may be initiated for patients at baseline CD4 counts of 101- 150 cells/ul of blood but change to another combination after three months to minimize toxicity associated with prolonged use.
- MST-Zoological Sciences