Adoption of evidence-informed guidelines in prescribing protease inhibitors for HIV-Tuberculosis co-infected patients on rifampicin and effects on HIV treatment outcomes in Uganda

• Published in: BMC infectious diseases 2021-08, Vol.21 (1), p.1-822, Article 822
• Main Authors: Mulindwa, Frank, Castelnuovo, Barbara, Kirenga, Bruce, Kalibbala, Dennis, Haguma, Priscilla, Muddu, Martin, Semitala, Fred C
• Format: Article
• Language: English
• Subjects: Antiretroviral therapy; Clinical outcomes; Clinics; Comorbid patients; Data collection; Dosage; Dosage and administration; Drug dosages; Drug interactions; Drug therapy; Drug therapy, Combination; Drug-drug interactions; Electronic health records; Failure rates; Health facilities; HIV; HIV infection; Hospitals; Human immunodeficiency virus; Infectious diseases; Laboratories; Lopinavir; Medical records; Medical referrals; Methods; Patient outcomes; Patients; Practice guidelines (Medicine); Protease; Protease inhibitors; Proteinase inhibitors; Public health; Rifampin; Ritonavir; Tuberculosis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06533-6

We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st--January -2013 and 30th--September--2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3-20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda's public HIV clinics but this does not seem to affect patient survival and viral suppression.