Sub therapeutic drug levels among HIV/TB co-infected patients receiving Rifampicin in northwestern Tanzania: A cross sectional clinic based study

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Daniel Gunda Samuel Kalluvya Christa Kasang Benson Kidenya Bonaventura Mpondo Hartwig Klinker

Abstract

Background: Tuberculosis/Human Immunodeficiency Virus (TB/HIV) is a very common
co-infection which carries a high mortality rate. Though World Health Organization recommends
co-treatment of TB/HIV to improve its outcome, Rifampicin potentially induces metabolism and
sub-therapeutic antiretroviral plasma levels of non nucleoside reverse transcriptase inhibitors and
protease inhibitors which may cause inadequate virological suppression if corrections are not timely
done. In Tanzania Therapeutic drug monitoring is not done; so the proportion of sub-therapeutic
ARV plasma levels among TB/HIV patients co-treated with anti-tuberculous drugs is not known.
The aim of this study was therefore to determine the magnitude and risk factors of sub-therapeutic
ARV plasma levels among adult HIV patients co-treated with anti tuberculous Medications.
Materials and methods: A cross sectional hospital based study was conducted among adult HIV
patients on ARV and TB co-treatment for at least one month. Patients were serially enrolled through
routine HIV care and treatment services until the sample size was reached. The information about
demographic, clinical and adherence level, Anti-TB duration, viral load, baseline and enrollment
CD4 counts, Hepatitis B co-infection and ARV plasma levels was collected and analyzed using
STATA 12 software.Results: In total 118 patients were included in this study; of whom 26 (22%) had sub-therapeutic
ARV plasma levels. The sub-therapeutic ARV levels were independently associated with adherence
<95% (OR =6.8, p= 0.001), female gender (OR = 3.4, p= 0.028) and virological failure
(OR= 3.8, p= 0.016). NVP based regimen was associated with sub-therapeutic drug levels on univariate
model (OR = 2.1, p= 0.010).
Conclusion: The magnitude of sub-therapeutic ARV plasma levels is high among adult HIV/TB coinfected
patients on anti-TB co-treatment in Tanzania. These patients stand a high risk of inadequate
virological suppression with a potential resistance development and a long term poor clinical outcome.
Identifying at risk patients and adherence enhancement could potentially improve the overall
outcome of this subgroup of patients in resource restricted setting like ours where TDM is not available.
2016 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Author Biographies

Daniel Gunda

Department of Internal Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania

Samuel Kalluvya

Department of Internal Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania

Christa Kasang

Institutes of Virology and Immunobiology, University of Wu¨rzburg, Wu¨rzburg, Germany
Medical Mission Institute, Wu¨rzburg, Germany

Benson Kidenya

Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania

Bonaventura Mpondo

Department of Internal Medicine, University of Dodoma, 1935 Dodoma, Tanzania

Hartwig Klinker

Division of Infectious Diseases, Department of Internal Medicine, University of Wu¨rzburg, Wu¨rzburg, Germany