Sub therapeutic drug levels among HIV/TB co-infected patients receiving Rifampicin in northwestern Tanzania: A cross sectional clinic based study

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 1 November 2016

Figures & data

Figure 1 The combined Anti retroviral therapy regimens. ∗ABC: Abacavir; AZT: Zidovudine; d4T: Stavudine; ddI: Didanosine; EFV: Efavirenz; FTC: Emtricitabine; LPV: Lopinavir; NPV: Nevirapine, r: ritonavir; TDF: Tenofovir; 3TC: Lamivudine.

Table 1 The baseline demographic, clinical and laboratory characteristics of 118 adult HIV Positive patients attending CTC at Bugando with ARV and anti-TB Co-treatment.

Factor	Number (%) or median [IQR]
Gender
Female	69 (58.5)
Males	49 (41.5)
Age (years)	38 [32–43]
Geographical location
Urban	52 (44.1)
Rural	66 (55.9)
WHO stage
Stage 3	75 (63.6)
Stage 4	43 (36.4)
BMI index(kg/M^2)
Under weight	22 (18.6)
Normal weight	79 (67.0)
Overweight	10 (8.5)
Obese	07 (5.9)
Hepatitis B
Positive	09 (07.6)
Negative	109 (92.4)
ARV regimes
EFV based	104 (88.1)
LPV based	10 (08.5)
NVP based	4 (03.4)
Subtherapeutic ARV	26 [22.0]
Subtherapeutic regimen
EFV	19 (18.3)
LPV	4 (40.0)
NVP#	3 (75.0)
Duration on ART (months)	10 [3–22]
Adherence level
>95%	92 (79.6)
<95%	24 (20.4)
Duration on anti-TB (months)	5 [2–6]
TB category
PTB Sputum Positive	71 (60.2)
PTB Sputum Negative	24 (20.3)
EPTB	23 (19.5)

∗ART: antiretroviral therapy, CD4: cluster of differentiation 4, CTC: Care and Treatment center; EFV: Efavirenz, EPTB: extra pulmonary TB, LPV: Lopinavir, NVP: Nevirapine, PTB: Pulmonary Tuberculosis.

Figure 2 Distribution of ARV plasma levels as sub-therapeutic, Therapeutic or supra-therapeutic among 118 adult HIV patients cotreated with TB drugs. ∗ARV: Antiretroviral; EFV: Efavirenz; HIV: Human immunodeficiency virus; LPV: Lopinavir; NVP: Nevirapine; TB: Tuberculosis.

Figure 3 Distribution of variables by plasma ARV drug levels as sub-therapeutic or therapeutic. ∗AD < 95%: Adherence level of less than 95%; AD > 95%: Adherence level of more than 95%; ARV: Antiretroviral; HepB pos: Hepatitis B positive; HepB neg: Hepatitis B positive; VF: virological failure; WHO: world health organization; WHO 3: WHO clinical stage 3; WHO 4: WHO clinical stage 4.

Table 2 Univariate and multivariate analysis for factors associated with sub-therapeutic ARV plasma levels among 118 adult HIV positive patients on TB co-treatment at Bugando.

Variables	Sub-therapeutic ARV levels		Unadjusted		Adjusted
	Yes (n) = 26	No (n) = 82	OR (95% CI)	p-Val	OR (95% CI)	p-Val
Gender
Male	06 (12.2)	43 (87.8)
Female	20 (29.0)	49 (71.0)	2.9 (1.1–7.9)	0.031	3.5 (1.1–10.6)	0.028
Age in years	33 [27–44]	38 [32–43]	1.0 (0.9–1.1)	0.513
Geog location
Urban	10 (19.2)	42 (80.8)
Rural	16 (24.2)	50 (75.8)	0.7 (0.3–1.8)	0.515
BMI index
Under WT	04 (18.2)	18 (81.8)
Normal WT	19 (24.1)	60 (75.9)
Over WT	03 (17.7)	14 (82.3)	1.0 (0.9–1.1)	0.842
WHO stage
Stage 3	16 (21.3)	59 (78.7)
Stage 4	10 (23.3)	33 (76.7)	1.1(0.5–2.7)	0.808
Initial CD4
<200 cells/μl	18 (22.8)	61 (77.2)
>200 cells/μl	08 (20.5)	31 (79.5)	0.9 (0.3–2.2)	0.779
Enroll CD4
<200 cells/μl	09 (20.0)	36 (80.0)
>200 cells/μl	17 (23.3)	56 (76.7)	1.2 (0.5–3.0)	0.676
HBV co-infection
Yes	03 (33.3)	06 (66.7)
No	23 (21.1)	86 (78.9)	0.4 (0.0–3.5)	0.424
Adherence
>95%	15 (16.0)	79 (84.0)
<95%	11 (45.8)	13 (54.2)	4.5 (1.7–11.8)	0.002	6.8 (2.2–20)	0.001
ART months	9.5 [22–20]	11 [33–22]	1.1 (0.9–1.4)	0.999
VL (copies/μl)
>400	11 (23.9)	35 (76.1)
<400	15 (20.8)	57 (79.2)	1.2(0.5–2.9)	0.694
VF (VL ⩾ 10^4/μl)
Yes	09 (39.1)	14 (60.9)
No	17 (17.9)	78 (82.1)	2.9(1.1–7.9)	0.027	3.8 (1.2–11.4)	0.016
Anti-TB months	5 [3–6]	1.1(0.9–1.4)	0.261
TB category
PTB SP	14 (19.7)	57 (80.2)
PTB SN	09 (37.5)	15 (62.5)
EPTB	03 (13.0)	20 (87.0)	1.0(0.6–1.7)	0.112
ARV regimen
EFV	19 (18.3)	85 (81.7)
LPV	04 (40.0)	06 (60.0)
NVP#	03 (75.0)	01 (25.0)	2.1(1.2–2.8)	0.010	-	-

∗ART: antiretroviral therapy, CD4: cluster of differentiation 4, CI: confidence interval, EFV: Efavirenz, EPTB: extra pulmonary TB, Geog: Geographical, HBV: Hepatitis B, IQR: Interquartile range, LPV: Lopinavir, NVP: Nevirapine, PTB: Pulmonary Tuberculosis, SN: Smear Negative, SP: Smear positive, VF: Virological failure, VL: viral load.