No abstract

No abstract

Since the early days of antiretroviral therapy, adherence has emerged a milestone to success. The objective of this study was to evaluate the factors militating against adherence to antiretroviral therapy among HIV-infected individuals in the resourcelimited setting of the Niger Delta of Nigeria. A structured interviewer-administered questionnaire from consecutively recruited 187 HIV-infected patients on combination antiretroviral therapy of two-nucleoside analogue; stavudine and lamivudine and one non-nucleoside (nevirapine) was used. Association between the independent variables and adherence were analyzed using chi square analysis. This study observed an adherence level of 49.2% and identified the following as factors associated with nonadherence: cost of antiretrovirals, educational status, medication adverse effect, occupational factors, and high pill burden of prescribed regimen (p < 0.05). There is an urgent need for universal access and sustainability of antiretroviral therapy particularly in resource-limited settings. There is need for supervised medication delivery. Efforts should be made towards simplifying the therapeutic regimen to reduce the pill burden and substitution with treatment combination and strategies that minimize negative adverse effects, coupled with the re-intensification of patient's education and counseling.

e Management of coinfection with malaria and HIV is a major challenge to public health in developing countries, and yet potential drug-drug interactions between antimalarial and antiviral regimens have not been adequately investigated in people with both infections. Each of the constituent components of artemether-lumefantrine, the first-line regimen for malaria treatment in Nigeria, and nevirapine, a major component of highly active antiretroviral therapy, are drugs metabolized by the cytochrome P450 3A4 isoenzyme system, which is also known to be induced by nevirapine. We examined potential interactions between lumefantrine and nevirapine in 68 HIV-positive adults, all of whom were diagnosed with asymptomatic Plasmodium falciparum infections by microscopy. Post hoc PCR analysis confirmed the presence of P. falciparum in only a minority of participants. Day 7 capillary blood levels of lumefantrine were significantly higher in HIV-positive participants than in 99 HIV-negative controls (P ‫؍‬ 0.0011). Associations between day 7 levels of lumefantrine and risk of persistent parasitemia could not be evaluated due to inadequate power. Further investigations of the impact of nevirapine on in vivo malaria treatment outcomes in HIV-infected patients are thus needed.