Effect of co-trimoxazole prophylaxis alone, zidovudine alone and co-trimoxazole prophylaxis plus zidovudine on haemoglobin level in Tanzania patients on antiretroviral therapy

Abstract

Background: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are a major global health problem and Sub-Saharan Africa is the world's most severely affected region. Prophylaxis against opportunistic infections and drug treatment directed to the virus has been associated with a decline in morbidity, mortality and improvement in the quality of life. However, use of these interventions is associated with side effects and toxicity. For example, anaemia is one of the important side effects of zidovudine. Co-trirnoxazole prophylaxis is given to all patients with high risk of opportunistic infections, yet co-trimoxazole can cause anaemia. When eo- trimoxazole is given together with zidovudine the likelihood of getting anaemia is higher.

In Tanzania, the new National Guidelines for the Management of HIV and AIDS (2008 3rd Edition). recommends zidovudine (AZT)-containing Highly Active Antiretroviral Therapy (HAART) as default first line regimen and co-trimoxazole (CTX) prophylaxis when T-lymphocyte cell count CD4 < 350 Cells/uL. Both drugs have possible side effects that include blood abnormalities which end up with neutropenia and anaemia. HIV Patients receiving both co-trimoxazole and zidovudine for long time are at risk of developing anaemia.

Objective: To determine the effect of zidovudine-containing HAART regimen ill combination with co-trimoxazole prophylaxis on haemoglobin concentration.

Methodology: This was retrospective, observational study conducted at Mwananyamala care and treatment center (CTC) located in Kinondoni Municipality.

Study populations: The study involved 407 Patients files of HIV -infected patients who were attending HIV CTC. The study had three arms:-

Those who were receiving none zidovudine-containing HAART regimen plus co-trimoxazole for prophylaxis

Those who were receiving zidovudine-containing HAART regimen alone