Prevalence and Determinants of Adverse Drug Events Among Hiv Infected Patients on Antiretroviral Therapy at Kenyatta National Hospital

Abstract

Background: HIV infection remains a threat to public health. Management of HIV infection normally includes the use of multiple antiretroviral drugs. There are various limitations of antiretroviral therapy (ART) which include adverse drug events (ADEs). Very few studies have been done on the limitations of ART especially in resource-constrained settings like Kenyatta National hospital. Study objectives: To assess the determinants and prevalence of adverse drug events of antiretroviral drugs among HIV infected patients at Kenyatta national hospital. Methods: A cross-sectional study was carried out at the comprehensive care center (CCC) of Kenyatta National Hospital. The target population was adult patients infected with HIV and on antiretroviral therapy. Four hundred patients were selected using simple random sampling from the CCC database but only 371 were studied. Data were abstracted from the electronic medical records and recorded on structured form designed to capture the variables of interest. The outcome variable was adverse drug events and adherence. The independent variables were the patient socio-demographic and clinical characteristics. The analysis of data was done using descriptive statistics such as tables, percentages, and graphs. Bivariate and multivariate analyses were conducted using Fischer’s exact and logistic regression. The level of significance was 0.05. Approval to carry out the research was granted by KNH/UON Research and Ethics Committee as well as Head of Department of CCC. Results: The study comprised of 371 participants and 241 (58%) were females. The mean age was 43.3years (± 11.5 SD) and the majority of the participants were married. The most commonly prescribed regimen was TDF/3TC/EFV. Hypertension was the most prevalent comorbidity followed by tuberculosis. The overall prevalence of adverse drug events (ADEs) was 34%. The most prevailing ADEs were peripheral neuropathy, headache, itchiness, and rash. The independent determinants of ADEs were regimen change (AOR 4.685, 95% CI 1.157-18.965, p value 0.03) and history of drug allergy (AOR 6.193, 95% CI 1.954 - 19.627, p value 0.002). Most of the participants had good adherence. The factors that independently influenced adherence were use of concomitant medications (AOR 0.088, 95% CI 0.008 - 10.925, P value 0.043), viral load (AOR 2 4.517, 95% CI 1.612 - 12.653, P value 0.04) and WHO clinical stage AOR 3.074, 95% CI 1.332 - 7.093, P value 0.008). Conclusion: The prevalence of adverse drug events was high. The level of non-adherence was lower than the recommended average level on non-adherence among patients with chronic disease. Recommendation: Measures for screening, prevention, and management of adverse drug events should be strengthened because the prevalence is still high.