Eight years of prevention of parent to child transmission of HIV-AIDS programme (PPTCT) in a tertiary care hospital in India

Abstract

Background: Urine tests for cannabis were positive in some of patients who were detained by law-enforcers. These patients, in their defense, claimed that the test results were false-positives caused by Efavirenz which they were taking for the treatment of HIV infection. While in detention, some patients were deprived of their Highly Active Antiretroviral Therapy (HAART). This issue has become controversial for the patients, the law-enforcement agencies and the doctors treating these patients.This study was done to evaluate if urine collected from patients taking Efavirenz would produce positive urine test results for cannabis using the same urinalysis method used by Malaysian lawenforcement agencies.Methods: Urine samples were collected from HIV-infected patients taking Efavirenz as part of HAART and tested for cannabinoids using the AxSYM Cannabinoids Assay® (Abbott, USA) which has a sensitivity of 13 ng/mL. Epidemiological data were collected from patient case notes and from face-to-face interviews. Descriptive analysis was done using SPSS® v.17 for Windows.Results: 44 patients on Efavirenz were recruited. The mean age was 44.8 years (23-73 years), 12 (27.3%) females. Mean-years on Efavirenz, 3.8 years (1-14 years). Mean CD4 cell count on HAART initiation, 123.7 cells/uL (4-377). All were compliant in taking Efavirenz in the preceding 7 days before recruitment and 38 (86.4%) took Efavirenz within 30 minutes of scheduled time while the rest took Efavirenz within 60 minutes of scheduled time. 4 patients had history of detention by law-enforcers; 2 were taking Efavirenz at the time, of which 1 tested positive for urine cannabis and he was deprived of HAART during detention. Urine test for cannabis was negative for all 44 patients. Conclusion:Urine tests for cannabis (using the AxSYM Cannabinoids Assay) were negative for all patients taking Efavirenz as part of HAART in this study. These patients were adherent to HAART. We conclude that Efavirenz is unlikely to be the cause of positive urine test for cannabis using the AxySYM Cannabinoids Assay which is used by law enforcement agencies in Malaysia.