Background:Chemotherapy induced nausea and vomiting (CINV) remains the most distressing event in patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC).Objective:Therefore, this meta-analysis was conducted to evaluate the efficacy of olanzapine containing regimen in preventing acute, delayed and overall phases of CINV.Methods:PubMed, EBSCO, and Cochrane central register of controlled trials electronic databases were searched to identify RCTs that compared the effects of olanzapine with non-olanzapine regimen in preventing CINV. Randomized clinical trials (RCTs) that compared olanzapine containing regimen with non-olanzapine regimen were included. The primary outcomes were the percentage of patients achieving no vomiting or no nausea in acute, delayed and overall phases.Results:13 RCTs that enrolled 1686 participants were included in this meta-analysis. 852 patients were assigned to olanzapine and 834 patients were assigned to non-olanzapine regimen (other standard antiemetic regimen). The percentages of no emesis achieved were 87.5%, 76.2%, 73.6% in olanzapine versus 76.7%, 61.8%, and 56.4% in non-olanzapine regimen in acute, delayed and overall phases, respectively. The percentages of no nausea were 82%, 64.3%, 61.6% in olanzapine group versus 71.3%, 41.8%, and 40.6% in non-olanzapine group in acute, delayed and overall phases, respectively. In general, olanzapine containing regimen achieved statistical superiority to non-olanzapine regimen in no vomiting endpoint in acute phase (OR 2.16; 95%CI 1.60 to 2.91, p<0.00001; I-square=5%; p=0.40), delayed phase (OR 2.28; 95%CI 1.1.46 to 3.54, p=0.0003; I-square=65%; p=0.001) and overall phase (OR 2.48; 95%CI 1.59 to 3.86, p<0.0001; I-square=69%; p< 0.0001).Conclusion:The current meta-analysis showed that olanzapine was statistically and clinically superior to non-olanzapine regimen in preventing CINV in most domains of the parameters.

Background: Combination antiretroviral therapy (cART) is the cornerstone of managing patients with HIV infection. Once cART is initiated, patients generally remain on medications indefinitely. However, antiretroviral regimens commonly require changes which often involve switches of multiple medications simultaneously. The maximal regimen durability with regard to safety and efficacy is a critical factor for long-term success of ART since modification to cART has a number of challenges.Objectives: To assess the rate, time to change, reasons and predictors of treatment modification among HIV/AIDS patients at Pawe General Hospital.Method: Hospital based retrospective cohort study was conducted among adult HIV/AIDS patients on follow-up in Pawe Hospital from 01 April 2017 to 30 April 2017. Patients who started cART at Pawe General Hospital from January 2012 to December 2016 were included. Data abstraction tool was used to collect data from patient chart. Data were analyzed using SPSS version 21. Descriptive statistics were used to summarize patient socio-demographics characteristics and rate of regimen modification. Bivariate and multivariate Cox proportional hazard were performed to identify the predictors. Result: Over a median follow-up period of 21 months (IQR 6 - 38), 62 (14.5%) patients modified their initial regimens (incidence rate (IR); 7.66 per 100 person years [95% CI: 5.84 – 9.50]). Toxicity was the most common reason (72.6%). In multivariate Cox regression model, WHO stage III/IV at initiation(AHR;2.39, 95% CI: 1.23 – 4.66), AZT based initial NRTI backbone (AHR; 8.19, 95% CI: 4.55 - 14.73), low baseline hemoglobin ((< 7 g/dl [AHR; 6.32, 95% CI: 1.40 – 28.58] and 7-9.9 g/dl [AHR 4.21, 95% CI: 1.92 - 9.22]) and co-medication with cART (AHR 1.73, 95% CI: 1.03 - 2.89) were associated with increased risk of treatment modification.Conclusion: Initial regimen modification rate was lower in this population than cohorts in resource-rich settings. Special attention should be given for patients who are at advanced disease stage, AZT based regimen, low baseline hemoglobin and taking additional medications other than cART.

No abstract