Stavudine or zidovudine in three-drug combination therapy for initial treatment of HIV infection in antiretroviral-naïve individuals

Spaulding, Alicen B; Rutherford, George W; Siegfried, Nandi

doi:10.1002/14651858.cd008651

Cited by 23 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study revealed that d4T use was associated with a higher probability of VF than AZT, even though previous clinical trials had revealed minimal difference in virologic efficacy between d4T and AZT . However, EFV use was associated with a lower probability of VF compared to NVP in the univariate model, which was further supported by data for both in vitro potency and from previous clinical trials .…”

Section: Discussionsupporting

confidence: 78%

Long‐term viral suppression and immune recovery during first‐line antiretroviral therapy: a study of an HIV‐infected adult cohort in Hanoi, Vietnam

et al. 2017

View full text Add to dashboard Cite

IntroductionAchieving viral suppression is key in the global strategy to end the HIV epidemic. However, the levels of viral suppression have yet to be described in many resource‐limited settings.MethodsWe investigated the time to virologic failure (VF; defined as a viral load of ≥1000 copies/ml) and changes in CD4 counts since starting antiretroviral therapy (ART) in a cohort of HIV‐infected adults in Hanoi, Vietnam. Factors related to the time to VF and impaired early immune recovery (defined as not attaining an increase in 100 cells/mm3 in CD4 counts at 24 months) were further analysed.ResultsFrom 1806 participants, 225 were identified as having VF at a median of 50 months of first‐line ART. The viral suppression rate at 12 months was 95.5% and survival without VF was maintained above 90% until 42 months. An increase in CD4 counts from the baseline was greater in groups with lower baseline CD4 counts. A younger age (multivariate hazard ratio (HR) 0.75, vs. <30), hepatitis C (HCV)‐antibody positivity (HR 1.43), and stavudine (d4T)‐containing regimens (HR 1.4, vs. zidovudine (AZT)) were associated with earlier VF. Factors associated with impaired early immune recovery included the male sex (odds ratio (OR) 1.78), HCV‐antibody positivity (OR 1.72), d4T‐based regimens (OR 0.51, vs. AZT), and nevirapine‐based regimens (OR 0.53, vs. efavirenz) after controlling for baseline CD4 counts.ConclusionDurable high‐rate viral suppression was observed in the cohort of patients on first‐line ART in Vietnam. Our results highlight the need to increase adherence support among injection drug users and HCV co‐infected patients.

show abstract

Section: Discussionsupporting

confidence: 78%

Long‐term viral suppression and immune recovery during first‐line antiretroviral therapy: a study of an HIV‐infected adult cohort in Hanoi, Vietnam

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Only few studies have compared outcomes between different ART regimens in sub-Saharan Africa [23, 24]. Our study is unique regarding its sample size and length of follow-up: it involved a large number of patients from a wide range of settings in southern Africa and described immunological recovery over five years after the initiation of ART.…”

Section: Discussionmentioning

confidence: 99%

Zidovudine impairs immunological recovery on first-line antiretroviral therapy

Wandeler¹,

Gsponer²,

Mulenga³

et al. 2013

Aids

View full text Add to dashboard Cite

Objectives Zidovudine (AZT) is recommended for first-line antiretroviral therapy (ART) in resource limited settings. AZT may, however, lead to anemia and impaired immunological response. We compared CD4 counts over 5 years between patients starting ART with and without AZT in Southern Africa. Design Cohort study Methods Patients aged ≥16 years who started first-line ART in South Africa, Botswana, Zambia or Lesotho were included. We used linear mixed-effect models to compare CD4 cell count trajectories between patients on AZT-containing regimens and patients on other regimens, censoring follow-up at first treatment change. Impaired immunological recovery, defined as a CD4 count below 100 cells/μl at 1 year, was assessed in logistic regression. Analyses were adjusted for baseline CD4 count and haemoglobin level, age, gender, type of regimen, viral load monitoring and calendar year. Results 72,597 patients starting ART, including 19,758 (27.2%) on AZT, were analysed. Patients on AZT had higher CD4 cell counts (150 vs.128 cells/μl) and haemoglobin level (12.0 vs. 11.0 g/dl) at baseline, and were less likely to be female than those on other regimens. Adjusted differences in CD4 counts between regimens containing and not containing AZT were −16 cells/μl (95% CI −18 to −14) at 1 year and −56 cells/μl (95% CI −59 to −52) at 5 years. Impaired immunological recovery was more likely with AZT compared to other regimens (odds ratio 1.40, 95% CI 1.22–1.61). Conclusions In Southern Africa AZT is associated with inferior immunological recovery compared to other backbones. Replacing AZT with another NRTI could avoid unnecessary switches to second-line ART.

show abstract

“…A meta-analysis of nine randomized control studies with a total of 2,159 patients comparing efficacy of cART containing d4T to ZDV found no statistically significant difference, but was limited by suboptimal data quality 96 . Stavudine also demonstrated comparable virologic efficacy as TDF in the 903 study, which compared TDF/3TC and efavirenz to d4T/3TC and efavirenz 60 .…”

Section: 0 Efficacy and Safety Of Combination N(t)rtismentioning

confidence: 99%

Combination Nucleoside/Nucleotide Reverse Transcriptase Inhibitors for Treatment of HIV Infection

Akanbi

Scarci

Taiwo

et al. 2011

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Introduction The combination of two nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTIs) and a third agent from another antiretroviral class is currently recommended for initial antiretroviral therapy. In general, N(t)RTIs remain relevant in subsequent regimens. There are currently six nucleoside reverse transcriptase inhibitors and one nucleotide reverse transcriptase inhibitor drug entities available, and several formulations that include two or more N(t)RTIs in a fixed dose combination. These entities have heterogeneous pharmacological and clinical properties. Accordingly, toxicity, pill burden, dosing frequency, potential drug-drug interaction, pre-existing antiretroviral drug resistance, and co-morbid conditions should be considered when constructing a regimen. This approach is critical in order to optimize virologic efficacy and clinical outcomes. Areas covered In this article, we review N(t)RTI combinations used in the treatment of HIV-infected adults. The pharmacological properties of each N(t)RTI, and the clinical trials which have influenced treatment guidelines are discussed. Expert Opinion It is likely that N(t)RTIs will continue to dominate the global landscape of HIV treatment and prevention, despite emerging interest in N(t)RTI-free combination therapy. Clinical domains where only few alternatives to N(t)RTIs exist include treatment of HIV/HBV co-infection and HIV-2. There is a need for novel N(t)RTIs with enhanced safety and resistance profiles compared to current N(t)RTIs.

show abstract

Stavudine or zidovudine in three-drug combination therapy for initial treatment of HIV infection in antiretroviral-naïve individuals

Cited by 23 publications

References 30 publications

Long‐term viral suppression and immune recovery during first‐line antiretroviral therapy: a study of an HIV‐infected adult cohort in Hanoi, Vietnam

Long‐term viral suppression and immune recovery during first‐line antiretroviral therapy: a study of an HIV‐infected adult cohort in Hanoi, Vietnam

Zidovudine impairs immunological recovery on first-line antiretroviral therapy

Combination Nucleoside/Nucleotide Reverse Transcriptase Inhibitors for Treatment of HIV Infection

Contact Info

Product

Resources

About