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Title: | Incidence and risk factors for neuropsychiatric events among Ghanaian HIV patients on long-term non-nucleoside reverse transcriptase inhibitor-based therapy |
Authors: | Sarfo, Fred Stephen Sarfo, Maame A. Chadwick, David |
Issue Date: | 2016 |
Publisher: | eNeurological Sci. |
Citation: | eNeurological Sci, 3 (2016) 21–25 |
Abstract: | Background: Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) is associated
with neuropsychiatric toxicity. Little is knownabout the risk of short- and long-term neuropsychiatric toxicity
in sub-Saharan Africa,whereNNRTIs arewidely used in first-line combination ART. This observational study
assessed the risk of neuropsychiatric toxicity in Ghanaian patients starting first-line ART between 2004 and
2010 at a single centre.
Methods: In this retrospective observational study, frequencies of documented neuropsychiatric toxicity events
were assessed and time to events calculated using a Kaplan–Meier analysis. Associations of neuropsychiatric toxicity
with specific NNRTIs and other explanatory variables were examined using Cox proportional hazards
modelling.
Results: Of 3999 patients initiating NNRTI-based ART, who were followed for a median of 30 (0.25–90) months
(11,237 person years), 218 (5.5%) reported symptoms of neuropsychiatric toxicity at a rate of 21.4 events per
1000 person-years (95% CI, 18.8–24.2/1000 py). Events were more common with efavirenz than nevirapine
(7.6% versus 2.4%), were usually reported within the first 2 months of ART initiation and persisted up to
84 months in a fewpatients. The most commonly reported neuropsychiatric adverse drug reactionswere insomnia
(50%), headaches (8%), dizziness (7%) and abnormal dreams (6%). The factors independently associatedwith
neuropsychiatric toxicity were BMI b 16 kg/m2 (aHR of 1.44 [95% CI, 1.02–2.03]) and use of efavirenz (aHR 3.29
[95% CI, 2.32–4.69]). Substitution of NNRTI on account of toxicitywas reported in up to 17% of patients experiencing
neuropsychiatric events.
Conclusions: NNRTI-related neuropsychiatric toxicity, mainly due to efavirenz, was infrequently documented in
this Ghanaian cohort under routine clinical care settings. Regimens with more favourable tolerability will be
needed as first-line agents in sub-Saharan Africa in the coming years. |
Description: | An article published in eNeurological Sci, 3 (2016) 21–25 |
URI: | http://hdl.handle.net/123456789/13359 |
Appears in Collections: | College of Health Sciences
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