Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Introduction: South Africa has the world’s largest antiretroviral treatment programme, which may contribute to
the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency
unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according
to HIV status, to determine the contribution of drugs used in management of HIV and its complications to
ADR-related EU presentations, and identify factors associated with ADR-related EU presentation.
Methods: We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month
period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with
the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and
preventability.
Results: We included 1010 EU presentations and assessed 80/1010 (7.9%) as ADR-related, including 20/239
(8.4%) presentations among HIV-positive attendees. Among HIV-positive EU attendees with ADRs 17/20 (85%)
were admitted, versus 22/60 (37%) of HIV-negative/unknown EU attendees. Only 5/21 (24%) ADRs in HIVpositive
EU attendees were preventable, versus 24/63 (38%) in HIV-negative/unknown EU attendees. On
multivariate analysis, only increasing drug count was associated with ADR-related EU presentation (adjusted
odds ratio 1.10 per additional drug, 95% confidence interval 1.03 to 1.18), adjusted for age, sex, HIV status,
comorbidity, and hospital.
Conclusions: ADRs caused a significant proportion of EU presentations, similar to findings from other resourcelimited
settings. The spectrum of ADR manifestations in our EUs reflects South Africa’s colliding epidemics of
infectious and non-communicable diseases. ADRs among HIV-positive EU attendees were more severe and less
likely to be preventable.
Description
CITATION: Mouton, J. P., et al. 2021. Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence. African Journal of Emergency Medicine, 11(1):46-52, doi:10.1016/j.afjem.2020.10.010.
The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicine
The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicine
Keywords
Drugs -- Side effects, Emergency medicine, HIV infections -- Complications
Citation
Mouton, J. P., et al. 2021. Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence. African Journal of Emergency Medicine, 11(1):46-52, doi:10.1016/j.afjem.2020.10.010