In spite of the benefits of Highly Active Antiretroviral Treatment (HAART), adverse effects, of which toxicity is a common finding which can lead to discontinuation, switch and non-adherence to therapy. Data on the impact of antiretroviral therapy and specifically on individual antiretroviral agents remain conflicting. A protective and contrary worsening effect has been reported for NVP and protease inhibitors. Differences in study design and methodologies may account for discrepancies. Overall, it is well accepted that HAART is beneficial and protects from disease progression in HIV infected subjects with increased survival of HIV-infected persons due to improved combination antiretroviral therapy and viral suppression, complications in this population have increased as well. These abnormalities could predispose the children and elderly population to adverse drug reactions. In the HIV-infected population this may be further compounded by cumulative drug exposure, as diagnosis remains more prevalent in younger populations, and earlier initiation of antiretroviral therapy is currently the rule. This would commit HIV patients to life-long antiretroviral therapy, and therefore to more opportunities for developing toxicity.
Understanding of HIV treatment increases with extensive experience, and modern antiretroviral agents with improved safety profiles continue to develop as a result it is assumed the incidence of HAART-related toxicity decrease over time. However, evidence in this field posed and lack of uniform definition and complexity of both patients and treatment regimens remains a challenge in the field. Moreover, HAART regimens are not yet validated for children while this group of population has a different and complex physiology.
As a result, children taking HAART might be significantly affected by the different toxicities including hepatotoxicity, nephrotoxicity, hematologic toxicity which could initially be explained by HAART induced inflammation. In this regard, there limited and controversial evidence on the impact of HAART on toxicities and inflammation which could be more worsening among children. Children were not part of these studies while they are presumed to be at high risk. Hence, our current study was aimed at evaluating inflammation, toxicities and their determinants among children taking HAART in Ethiopia.
The finding from this study reported, 65.6% children taking HAART in Ethiopia developed inflammation. while vitamin-D deficiency was 36%. A quarter of the children (25.3%) were at grade-4 level liver toxicity while renal toxicity was 2.9%. A third (29.6%) of the children also developed anemia. Children who are on TDF+3TC+EFV, not virally suppressed and with liver toxicity were at risk of inflammation. Children taking TDF+3TC+EFV, with CD4 count of <200 cells/mm3 and with renal toxicity were at risk of vitamin-D deficiency. Determinants of liver toxicity were history of HAART substitution and being bedridden. Renal toxicity was associated with family HIV status as being positive, type of HAART. Factors associated with anemia was being female and taking AZT+3TC+EFV.
Penulis: Prof. Maria inge Lusida, dr., Ph.D., M.Kes., Sp.MK(K)
Informasi detail dari riset ini dapat dilihat pada tulisan kami di:
Getaneh, Y., Lejissa, T., Getahun, T., khairunisa, S. qamariyah, Husada, D., Kuntaman, K., & Lusida, M. I. (2023). HAART induced inflammation, toxicity and its determinants among HIV positive children in Addis Ababa, Ethiopia. Heliyon, 9(5), e15779. : Heliyon
