Abhay S. Tirkey, Uppal Rashmi Kunkal
BACKGROUND It is estimated that there are 35.5 million PLHA worldwide and 1.6 million have received ART. ART is freely available in designated ART centers. The main challenge in prescribing HAART along with ATT is ADRs associated with it affecting patient compliance and treatment outcomes. MATERIALS AND METHODS This is a cross sectional study of 100 patients who were on TLE therapy for one year. Of these 100 patients, half were on ART alone (Group-A); half were on ART and ATT both (Group-B). Complete work up as per NACO guideline and nerve conduction study of all patients was performed. Results were analysed in the light of clinical, laboratory test and NCV studies. RESULTS Data for neuropathy and other ADRs was collected from 100 patients over a period of one year. It shows gastrointestinal disturbance as the most common adverse event followed by neuropathy. Overall incidence of neuropathy in both groups was 59%. Asymptomatic neuropathy was present in 58% of patients. Commonest symptoms of neuropathy were pain in calf muscle, ankle and sole (83%). Most common sign was reduced distal superficial sensation (88%). Knee jerk was diminished in 84.44% of patients. Commonest type of neuropathy on Nerve Conduction Study was distal axonal neuropathy (94.44%) with NCS showing reduced amplitude of sensory nerve action potential and reduced compound motor action potential. Statistically significant incidence of neuropathy was found among the Group B patients having low CD4 count and advanced HIV infection. Incidence of neuropathy in patients with >11 months exposure to TLE was 69.49% as compared to 30.51% in <11 months group. CONCLUSION There is significant additive effect of ATT in development of neuropathy in patients on TLE with advanced HIV infection. It is an independent risk factor for development of neuropathy. The real burden of ADRs due to ART and ATT (anti tubercular treatment) cannot be estimated until voluntary and mandatory reporting system of ADRs work efficiently. A structured surveillance of the pharmacovigilance system can help to overcome these hurdles to ensure compliance with ART regimens.
