Is zidovudine first‐line therapy virologically comparable to tenofovir in resource‐limited settings?

Abstract

Abstractobjective To compare virologic success between adult patients on tenofovir (TDF) and zidovudine (AZT)-containing first-line antiretroviral (ART) regimens in 10 rural clinics in Lesotho, Southern Africa.methods Multicentre cross-sectional study, patients ≥16 years, on first-line ART ≥6 months, receiving AZT/lamivudine (3TC) or TDF/3TC combined with efavirenz (EFV) or nevirapine (NVP). Patient characteristics and clinical/therapeutic history were collected on the day of blood draw for viral load (VL). Analysis was stratified for non-nucleoside reverse transcriptase inhibitor (EFV or NVP). A logistic regression model weighted for patients' baseline characteristics was used to assess the likelihood of virologic success (<80 copies/ml) in patients with TDF-as compared to AZTbackbones.results In total 1539 patients were included in the analysis. Most were clinically and immunologically stable (clinical failure: 2.7% (AZT) and 2.8% (TDF); immunological failure: 4.6% (AZT) and 4.8% (TDF)). In EFV-based regimens (n = 1162), TDF was significantly associated with higher rates of virologic suppression than AZT (93.8% vs. 88.1%; weighted odds ratio: 2.15 (95% CI: 1.29-3.58; P = 0.003)). In NVP-based regimens, a similar trend was observed, but not significant (89.4% vs. 86.7%; 1.99 (0.83-4.75, P = 0.121)).conclusion These findings support the WHO recommendation to use TDF/3TC/EFV as first-line regimen. They do, however, not support the recommendation that patients who are clinically stable on AZT should continue on this first-line regimen.

Metabolic syndrome in patients on first‐line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa

“…In the same patient cohort, we previously described the lower rates of viral suppression under AZT‐ vs . TDF‐containing regimens . Our finding of higher rates of MetS among women taking AZT is another important point endorsing the WHO‐recommended policy of TDF as the preferred NRTI backbone in first‐line ART for resource‐limited settings.…”

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

“…Tenofovir disoproxil fumarate (TDF) is a widely prescribed nucleoside analogue reverse transcriptase inhibitor (NRTI) for first-line or second-line antiretroviral therapy (ART) for HIV-1 infection, even in resource-limited settings 1234. Generally, TDF is used in fixed-dose drug combinations as an NRTI backbone with emtricitabine, emtricitabine/efavirenz, emtricitabine/ripivirine, or emtricitabine/elvitegravir/cobicistat as a once-a-day single-tablet regimen.…”

Zidovudine- versus Tenofovir-Based Antiretroviral Therapy for the Initial Treatment of HIV Infection in the Ethnic Minority Region of Liangshan Prefecture, Sichuan Province, China

“…Although studies comparing TDF-versus ZDV-based regimens for treatment of HIV infection have demonstrated superior safety of TDF-over ZDV-based HAART, data on virologic suppression have yielded mixed results. [4][5][6][7][8][9][10] In 2010, areas of the Liangshan Prefecture located in Sichuan Province had an 11% prevalence of HIV among adults, making this the highest prevalence region in China. 11 In a pilot project starting in 2011, our center located in Liangshan Prefecture, replaced ZDV with TDF as part of the preferred HAART regimen for treatment-naive HIV-infected patients.…”