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首页> 外文期刊>eNeurologicalSci >Incidence and risk factors for neuropsychiatric events among Ghanaian HIV patients on long-term non-nucleoside reverse transcriptase inhibitor-based therapy
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Incidence and risk factors for neuropsychiatric events among Ghanaian HIV patients on long-term non-nucleoside reverse transcriptase inhibitor-based therapy

机译：长期使用非核苷类逆转录酶抑制剂为基础的加纳艾滋病毒患者神经精神事件的发生率和危险因素

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Background Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) is associated with neuropsychiatric toxicity. Little is known about the risk of short- and long-term neuropsychiatric toxicity in sub-Saharan Africa, where NNRTIs are widely used in first-line combination ART. This observational study assessed the risk of neuropsychiatric toxicity in Ghanaian patients starting first-line ART between 2004 and 2010 at a single centre. Methods In this retrospective observational study, frequencies of documented neuropsychiatric toxicity events were assessed and time to events calculated using a Kaplan–Meier analysis. Associations of neuropsychiatric toxicity with specific NNRTIs and other explanatory variables were examined using Cox proportional hazards modelling. Results Of 3999 patients initiating NNRTI-based ART, who were followed for a median of 30 (0.25–90) months (11,237 person years), 218 (5.5%) reported symptoms of neuropsychiatric toxicity at a rate of 21.4 events per 1000 person-years (95% CI, 18.8–24.2/1000 py). Events were more common with efavirenz than nevirapine (7.6% versus 2.4%), were usually reported within the first 2months of ART initiation and persisted up to 84months in a few patients. The most commonly reported neuropsychiatric adverse drug reactions were insomnia (50%), headaches (8%), dizziness (7%) and abnormal dreams (6%). The factors independently associated with neuropsychiatric toxicity were BMI<16kg/m 2 (aHR of 1.44 [95% CI, 1.02–2.03]) and use of efavirenz (aHR 3.29 [95% CI, 2.32–4.69]). Substitution of NNRTI on account of toxicity was reported in up to 17% of patients experiencing neuropsychiatric events. Conclusions NNRTI-related neuropsychiatric toxicity, mainly due to efavirenz, was infrequently documented in this Ghanaian cohort under routine clinical care settings. Regimens with more favourable tolerability will be needed as first-line agents in sub-Saharan Africa in the coming years. Highlights ? Millions of patients living with HIV AIDS in sub-Saharan Africa are initiated on an efavirenz-based combination antiretroviral therapy which is frequently associated with neuropsychiatric toxicity. ? In this retrospective study involving 3999 Ghanaian HIV-infected patients initiating therapy between 2004 and 2010, neuropsychiatric toxicity was documented in 5.5% with a higher incidence among efavirenz recipients (7.6%) compared with nevirapine recipients (2.4%). ? Peak neuropsychiatric adverse events occurred within the first two months upon initiating therapy with some few further events occurring as later on during 90months of follow-up. ? Up to 17% of patients reporting neuropsychiatric toxicity had treatment modifications as a result.
机译：背景技术基于非核苷类逆转录酶抑制剂（NNRTI）的抗逆转录病毒疗法（ART）与神经精神毒性有关。在撒哈拉以南非洲，人们对短期和长期神经精神毒性的风险知之甚少，在那里，NNRTIs被广泛用于一线联合抗逆转录病毒疗法。这项观察性研究评估了加纳患者于2004年至2010年在一个中心开始一线抗病毒治疗的神经精神毒性毒性风险。方法在这项回顾性观察性研究中，使用Kaplan-Meier分析评估了记录的神经精神毒性事件的发生频率，并计算了事件发生时间。使用Cox比例风险模型研究了神经精神毒性与特定NNRTI和其他解释变量的关联。结果3999例患者开始接受基于NNRTI的抗逆转录病毒疗法，中位随访30（0.25-90）个月（11,237人年），其中218（5.5％）发生神经精神毒性症状，每1000人中有21.4事件发生年（95％CI，18.8-24.2 / 1000 py）。依非韦伦组的事件比奈韦拉平组的事件更为常见（7.6％比2.4％），通常在抗病毒治疗开始的前2个月内报告，并在少数患者中持续至84个月。最常见的神经精神药物不良反应是失眠（50％），头痛（8％），头晕（7％）和梦境异常（6％）。与神经精神毒性独立相关的因素是BMI <16kg / m 2（aHR为1.44 [95％CI，1.02–2.03]）和依非韦伦的使用（aHR 3.29 [95％CI，2.34-4.69]）。据报道，多达17％的发生神经精神病事件的患者因毒性而替代了NNRTI。结论在常规临床护理情况下，该加纳队列中很少记录到主要由依非韦伦引起的与NNRTI相关的神经精神毒性。未来几年，在撒哈拉以南非洲地区，需要具有更好耐受性的药物作为一线药物。强调 ？撒哈拉以南非洲地区数百万艾滋病毒/艾滋病患者开始使用基于依非韦伦的联合抗逆转录病毒疗法，该疗法通常与神经精神毒性相关。 ？在这项涉及2004年至2010年期间开始治疗的3999名加纳HIV感染患者的回顾性研究中，据记录神经精神毒性为5.5％，依非韦伦接受者（7.6％）的发生率高于奈韦拉平接受者（2.4％）。 ？在开始治疗后的头两个月内出现了严重的神经精神不良事件，随后的90个月中又出现了一些其他事件。 ？结果，多达17％的报告神经精神毒性的患者进行了治疗修改。

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