Document Detail


Haematological changes in adults receiving a zidovudine-containing HAART regimen in combination with cotrimoxazole in Côte d'Ivoire.
MedLine Citation:
PMID:  16152755     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Neutropenia is the most frequent side effect of cotrimoxazole in sub-Saharan Africa. We estimated the incidence of haematological disorders during the first 6 months of a zidovudine-containing highly active antiretroviral therapy (HAART) regimen in sub-Saharan African adults receiving cotrimoxazole. METHODS: Prospective cohort study in Abidjan, with blood cell count measurement at baseline (HAART initiation), month 1, month 3 and month 6. RESULTS: A total of 498 adults [baseline: 80% currently on cotrimoxazole prophylaxis; median CD4 count 237/mm3 [interquartile range (IQR) 181;316]; median neutrophil count 1647/mm3 (IQR 1221;2256); median haemoglobin 113 g/l (IQR 102;122)] started zidovudine (AZT)/lamivudine/efavirenz. During follow-up, 118 patients had a grade 3-4 neutropenia [(56.3/100 person-years (PY)], 23 had a grade 3-4 anaemia (9.6/100 PY) and no cases of grade 3-4 thrombocytopenia. Of the 118 patients with grade 3-4 neutropenia, 86 (73%) had to stop cotrimoxazole because neutropenia persisted, and one (<1%) had to stop AZT because of persistent neutropenia after cotrimoxazole was stopped (neutropenia-related HAART modification: 0.4/100 PY). Of the 23 patients with grade 3-4 anaemia, 11 had to stop AZT (anaemia-related HAART modification: 4.4/100 PY). In patients who stopped cotrimoxazole but not AZT, the median gain in neutrophils at 1 month was +540/mm3 (IQR +150;+896). CONCLUSIONS: At baseline, most patients had a normal neutrophil count and 80% of them were already receiving cotrimoxazole. An unexpectedly high rate of grade 3-4 neutropenia occurred shortly after introduction of AZT. Almost all of the persistent severe neutropenia disappeared after cotrimoxazole was stopped. This suggests an accentuated drug interaction between the two drugs in these sub-Saharan African individuals. Grade 3-4 anaemia was much less frequent, but remained the first cause of AZT discontinuation.
Authors:
Raoul Moh; Christine Danel; Souleymane Sorho; Delphine Sauvageot; Amani Anzian; Albert Minga; Olivier Ba Gomis; Constance Konga; André Inwoley; Delphine Gabillard; Emmanuel Bissagnene; Roger Salamon; Xavier Anglaret
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Antiviral therapy     Volume:  10     ISSN:  1359-6535     ISO Abbreviation:  Antivir. Ther. (Lond.)     Publication Date:  2005  
Date Detail:
Created Date:  2005-09-12     Completed Date:  2005-10-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9815705     Medline TA:  Antivir Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  615-24     Citation Subset:  IM    
Affiliation:
Programme PAC-CI, Abidjan, Côte d'Ivoire.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anemia / etiology*
Anti-HIV Agents / adverse effects,  therapeutic use
Anti-Infective Agents / adverse effects*,  therapeutic use
Antiretroviral Therapy, Highly Active
Blood Cell Count
Blood Platelets / immunology
Cohort Studies
Cote d'Ivoire
Drug Therapy, Combination
Female
HIV Infections / drug therapy*,  immunology
Humans
Male
Neutropenia / etiology*
Prospective Studies
Thrombocytopenia / etiology*
Trimethoprim-Sulfamethoxazole Combination / adverse effects*,  therapeutic use
Zidovudine / adverse effects*,  therapeutic use
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Anti-Infective Agents; 30516-87-1/Zidovudine; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination

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