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Malawi Medical Journal
College of Medicine, University of Malawi and Medical Association of Malawi
ISSN: 1995-7262
Vol. 23, No. 4, 2011, pp. 116-118
Bioline Code: mm11030
Full paper language: English
Document type: Research Article
Document available free of charge

Malawi Medical Journal, Vol. 23, No. 4, 2011, pp. 116-118

 en Underreporting of side effects of standard first-line ART in the routine setting in Blantyre, Malawi.
Tapsfield, Julia; Mathews, Teena; Lungu, Molly & van Oosterhout, Joep J.


In the Malawi ART programme, 92% of 250,000 patients are using the standard first-line regime of stavudine-lamivudine-nevaripine. National ART reports indicate <4% experience ART side effects, much less than expected from literature.
We interviewed adult patients on standard first-line ART for at least one year, after routine visits to an urban clinic in Blantyre, Malawi. We determined the prevalence of symptoms that are common side-effects, described discrepancies between symptoms that patients reported to us and those that had been recorded by attending staff as side-effects in the point-of-care electronic monitoring system, and studied factors associated with such discrepancies.
Of 170 participants, 75 (44%) reported at least one symptom, most common were symptoms suggesting peripheral neuropathy (n=57) and lipodystrophy (n=16). Forty-six (66%) symptomatic patients said they reported symptoms to attending ART staff. Side-effects were recorded in the clinic database for just 4 patients. Toxicity recording was too low for meaningful analysis of factors associated with discrepancies between reporting and recording of side-effects. The prevalence of symptoms indicating characteristic side-effects of the standard first-line regimen was 39% based on interviews, and 2% in the electronic monitoring system.
There was gross under-recording of side-effects in this setting, mainly due to not recording by ART staff. Pressure of work and insufficient perceived benefit of side-effect recording are suspected causes. Local and national ART reports do not reflect the true toxicity of the standard firstline regimen.

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