Adverse drug reactions to antiretroviral treatment among people living with HIV at HIV clinic, Colombo, Sri Lanka

Sri Lankan PLHIV are managed adhering to national antiretroviral treatment (ART) guidelines. Since 2016 all the PLHIV were offered ART irrespective of their CD4 count. Some PLHIV experience Adverse drug reactions (ADRs) which result in sub-optimal patient and programmatic outcomes. Therefore, this study was designed to determine the prevalence of ADRs and to identify the causality, severity and preventability.
A clinic based retrospective cohort study was conducted among all PLHIV registered for ART at the HIV clinic, Colombo until 31st December 2019. The data was collected on the ADRs that occurred from January 2015- December 2019. Each ADR was appraised using Naranjo’s algorithm, modified Hartwig and Seigel scale, Shumock and Thornton criteria.
The cohort included 1028 patients of whom 90 (8.7%) developed ADRs. Predominant ADR were hypersensitivity reactions (32%). Evaluation of ADRs through Naranjo’s scale denoted that 55 (61%) were probably and 33 (37%) were possibly due to ART. Majority of ADRs were mild 59 (65%) and 7% were severe. Only 2% of ADR were preventable. Out of all the patients exposed to the corresponding drug, percentage occurrence of ADRs were highest with atazanavir (32.5%) followed by raltegravir (9%) and efavirenz (5.9%). Majority (58.8%) of the ADRs, including all the severe ADRs occurred within 6 months of commencement of ART.
As bulk of these ADR are predictable, frequent reviews should be made especially during the first 6 months of ART initiation. Introduction of newer ART drugs (Dolutegravir) with lesser toxicity in the updated ART guidelines in 2020 will increase adherence to ART.