DEVELOPMENT AND IMPLEMENTATION OF STRATEGIES TO PREVENT OR MINIMIZE ADVERSE DRUG REACTIONS TO ANTIRETROVIRAL MEDICATIONS IN TREATMENT NAiVE HIV PATIENTS

Abstract

Background: Incidence of adverse drug reactions (ADRs) to antiretrovirals (ARVs) is constantly increasing. Objective: To identify the ADRs to ARVs in HIV patients and to develop and implement the strategies to prevent or minimize ADRs associated with ARVs. Methodology: An ambispective observational study was conducted at HIV care hospital over a period of 18 months to identify, assess and document the ADRs to ARVs. Based on this, strategies were developed and implemented by conducted prospective interventional study. Results: Out of 1050 patients reviewed, 380 patients experienced 440 ADRs with an incidence of 36.2%. Predictable reactions accounted for 95% (n=419) and 25% (n=109) were not preventable. Strategies like adding cinnarizine to patients started with T+L+E regimen to prevent dizziness, ranitidine with Z+L+N regimen to prevent gastritis, and hydroxychloroquine (HCQ) in patients with TB-IRIS. Out of 300 patients receiving T+L+E regimen, 22.6% were experienced ADRs in the interventional group (given with cinnarizine + patient counseling) compared to 36% among non-interventional group. Out of 100 patients receiving Z+L+N regimen, 18% were experienced with ADRs in the interventional group (given with ranitidine + patient counseling) compared to 28% among non-interventional group. Among 40 patients with TB-IRIS given with HCQ, 33 (82.5%) patients were improved symptomatically. Conclusion: The overall incidence of ADRs among HIV patients was found to be 36.2%. Implementation of the strategies was found to be useful to prevent or minimize dizziness in patients receiving T+L+E regimen and gastritis in patients receiving Z+L+N regimen. In paradoxical TB-IRIS patients, symptoms were minimized with the administration of HCQ. newline