591
Clinical Monitoring of Cotrimoxazole, Duovir, and Nevimmune (Generic HAART) among Men and Women with AIDS in Zimbabwe
D Bhattacharaya1,2, G Kadzirange*1,2, L S Zijenah1, E Matsikire3, S Moyo3,4, T Kufa3,4, O Tobaiwa3, M Chirenje1,2, C Maponga1, R Machekano1,5, D A Katzenstein2, and Zimbabwe AIDS Prevention Project
1Univ. of Zimbabwe, Harare; 2Stanford Univ., CA, USA; 3Zimbabwe AIDS Prevention Project, Harare; 4Medicin Sans Frontier, Harare, Zimbabwe; and 5San Mateo County AIDS Prgm., CA, USA
Background: Sustainable antiretroviral therapy (ARV) will
require community-based treatment and monitoring. We evaluated toxicity and
morbidity of cotrimoxazole (CTX)
and generic ARV.
Methods: We enrolled 191 women and 57 men in community-based
AIDS care in Chitungwiza, Zimbabwe. Evaluation included
complete blood count, CD4 counts, clinical exam, and TB testing. CTX was offered to those with <200 CD4 cells or
WHO stage >II disease. Generic AZT + 3TC + NVP were offered after >8
weeks of CTX and counseling. Clinical
monitoring was conducted by nurses and community counselors. Those with signs
or symptoms were referred to the physician.
Results: Median CD4 at enrolment was 273 (range 2 to 1087).
Women had significantly higher CD4 counts than men at WHO stages I and II (p <0.03). A CD4 <200/mm3 was more frequent in men 31/57 (52%) than women
51/191 (26%) (p <0.01). Of 248, 7
(3%) were sputum AFB+. As of September 2003, 62 initiated CTX and 44 ARV. Rash led to CTX
discontinuation in 2/62 (3%) within 2 to 4 weeks. Among those on ARV, adverse
events prompted evaluation in 19/44 (43%). Rash occurred in 6 (14%) on ARV,
severe anemia and neutropenia developed in 1. Pneumonia was diagnosed in 8
(18%); 1 died with presumptive PCP
at 1 month, while 7 responded to oral antibiotics. Of those on ARV, pneumonia
and rash were significantly associated with a lower mean neutrophil count at
study entry 1.32±1.29
vs 2.05±1.75
cells x 103/mm3 (p = 0.025)
Conclusions: Clinical monitoring of CTX and generic ARV by counselors and nurses
identified potential drug related toxicities (rash) and a high frequency of
pneumonia among patients with AIDS in Zimbabwe. Neutropenia was
associated with an increased risk of respiratory infections and rash. Community-based
clinical ARV and CTX monitoring is
a feasible approach in resource-constrained settings.
Keywords: generic; Zimbabwe; antiretrovirals
