Several challenges exist in resource-limited settings between balancing the cost and toxicity that occurs during antiretroviral therapy (ART). Most HIV-infected patients in resource-limited settings receive a first-line triple combination of lamivudine, nevirapine, and stavudine or zidovudine [1
]. Typical examples of ART in these settings include the World Health Organization prequalified fixed-dose combinations of stavudine/lamivudine/nevirapine (D4T/3TC/NVP) and zidovudine/lamivudine/nevirapine (AZT/3TC/NVP), which are being widely promoted in highly active antiretroviral therapy (HAART) “scale-up” programs.
ART is associated with a variety of adverse drug reactions (ADRs) that can hamper treatment adherence. Particularly, there is concern about the risk for peripheral neuropathy with use of stavudine, especially among patients with lower CD4 cell counts [2
] and the risk of rash (including Stevens Johnson syndrome), hypersensitivity, and life-threatening hepatotoxicity with use of nevirapine, especially among women and those with higher CD4 cell counts at initiation of therapy [3
]. In Sub-Saharan Africa, different incidence rates have been identified for ADRs associated with ART. The most commonly evaluated regimen in Sub-Saharan Africa is the D4T/3TC/NVP combination and this has been associated with various rates of ADRs in different settings [6
Traditional herbal remedies have been used to treat many ailments in Zimbabwe for many years before the introduction of orthodox medicines. The advent of HIV/AIDS in Zimbabwe increased the popularity and use of herbal remedies because antiretroviral drugs were not available at that time [14
]. Studies in South Africa have shown that herbal remedies are good supplements to antiretroviral therapy because of their immune boosting properties [15
]. A study in western Uganda found that 38% of HIV-positive patients used traditional medicines and antiretroviral drugs at the same time for the management of HIV infection [16
]. The major reasons for use of traditional medicines were perceived additional efficacy, improvement in quality of life, and a feeling of control over the disease. The majority of traditional medicines currently being used by patients have not been thoroughly researched. The impact of coadministration of traditional herbal medicine with orthodox medicine has not yet been fully evaluated and consequently there is a lack of data which pertains to this subject. Patients are currently taking herbal medicines with orthodox medicines without the knowledge of how this affects them.
Research is required to determine factors which affect occurrence of ADRs associated with ART. Identification of patients at different levels of risk may identify subgroups requiring different monitoring intensities. An evaluation of the potential of the most widely used herbal remedies to interact with antiretroviral drugs may be helpful in improving the clinical outcome of patients on ART. It would enable risk identification and assessment, and if necessary, execution of risk reduction strategies. In view of the above, the objective of this study was to determine the impact of coadministration of herbal therapy with ART on ADRs.