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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Haematological changes in adults receiving a zidovudine-containing HAART regimen in combination with cotrimoxazole in Côte d'Ivoire
Antiviral Therapy, Volume 10, No. 5, Year 2005
Notification
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Description
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 HMRT 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. © 2005 International Medical Press.
Authors & Co-Authors
Moh, Raoul D.
Cote D'ivoire, Abidjan
Programme Pac-ci
Danel, Christine
Cote D'ivoire, Abidjan
Programme Pac-ci
Sorho, Souleymane
Cote D'ivoire, Abidjan
Programme Pac-ci
Sauvageot, Delphine
Cote D'ivoire, Abidjan
Programme Pac-ci
Anzian, Amani
Cote D'ivoire, Abidjan
Centre de Prise en Charge de Recherche et de Formation
Minga, Albert Kla
Cote D'ivoire, Abidjan
National Blood Transfusion Center
Ba-Gomis, Olivier
Cote D'ivoire, Abidjan
Cirba
Kanga, Constance
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Inwoley, André
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Gabillard, Delphine
France, Paris
Inserm
Bissagnéné, Emmanuel
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Salamon, Roger L.
Cote D'ivoire, Abidjan
Programme Pac-ci
France, Paris
Inserm
Anglaret, Xavier
Cote D'ivoire, Abidjan
Programme Pac-ci
France, Paris
Inserm
Statistics
Citations: 13
Authors: 13
Affiliations: 6
Identifiers
ISSN:
13596535
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Ivory Coast