Abstract:
Background: Successful antiretroviral therapy (ART) has changed the outlook of Human
Immunodeficient Virus (HIV) patients. However, ART is complicated by adverse drug effects
and immune reconstitution inflammatory syndrome (IRIS) events. Objective: To describe the clinical events and CD4 cell count changes following initiation of ART in HIV adult patients at care and treatment clinic (CTC), Mbeya Referral Hospital (MRH). Study design and setting: A retrospective follow-up study conducted at the CTC, MRH between April 2007 and August 2007. Methodology: A standard data collection form was used to collect information from the patients' files and the clinic database. Results: A total of 1475 HIV patients 61.6% females and 38.4% males were studied. Clinical events characteristic of drug adverse effects were significant after one month of ART and suspected IRIS events were 13.1%, 6.2% and 6.3% at 1, 3 and 6 months following the initiation of ART. No significant difference was seen in the increase in CD4 cell counts by the use of either nevirapine or efavirenz containing regimen. There was a significant association between previous opportunistic infection of TB and the occurrence of clinical events of genital ulcers at 3 months following initiation of ART . Other clinical events had no association with previous opportunistic infection. Baseline CD4 cell count of::; 100 cells/ul, and ~101 cells/uL were significantly associated with peripheral neuropathy and abdominal pain 1 month following ART respectively and at 3 months after start of ART peripheral neuropathy was significant among patients with a baseline CD4 cell count of ::; 100 cells/ul.Baseline hemoglobin level of~12.5 g/dL was significantly associated with hemoptysis after 1 month of ART. At 3 months following initiation of ART patients with a baseline WBC count of > 4.5 x 103 / ~L had significant increase in oral thrush and headache was more at 3 months after ART among patients with baseline WBC counts of:S 4.4 x 103/ ul.. Chest pain and headache at 6 months after initiation of ART were significant among patients with baseline WBC counts of'< 4.4 x 103/ ul., Conclusion and recommendation: Clinical events following the initiation of ART are common and occur due to adverse effects of the drugs but also as suspected IRIS events. Patients starting ART should be closely monitored for adverse drug effects and IRIS especially soon after the start of ART. Prospective clinical studies need to be done to properly diagnose IRIS.
