JAIDS Journal of Acquired Immune Deficiency Syndromes. 56(3):e75-e78, MARCH 1ST, 2011
DOI: 10.1097/QAI.0b013e3182097505
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PMID: 21164354
Issn Print: 1525-4135
Publication Date: March 1st, 2011
Implementing a Tenofovir-Based First-Line Regimen in Rural Lesotho: Clinical Outcomes and Toxicities After Two Years
Helen Bygrave;Nathan Ford;Gilles Cutsem;Katherine Hilderbrand;Guillaume Jouquet;Eric Goemaere;Nathalie Vlahakis;Laura Triviño;Lipontso Makakole;Katharina Kranzer;
+ Author Information
From the *Médecins Sans Frontières, Morija, Lesotho; †Médecins Sans Frontières, Cape Town, South Africa; ‡Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; §Scott Hospital, Morija, Lesotho; and ‖Department of Epidemiology and Population Health, Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Abstract
The latest World Health Organization guidelines recommend replacing stavudine with tenofovir or zidovudine in first-line antiretroviral therapy in resource-limited settings. We report on outcomes and toxicities among patients on these different regimens in a routine treatment cohort in Lesotho.All adult patients initiating antiretroviral therapy from January 1, 2008, to December 31, 2008, were included in the analysis and followed until December 31, 2009. Choice of regimen was determined by clinical criteria.Of 1124 patient records analyzed, median age was 39 years, and the majority (67.7%) were women. Five hundred eighty-seven patients were started on tenofovir, 255 on zidovudine, and 282 on stavudine. Patients on zidovudine were more than twice as likely to experience a toxicity-driven regimen substitution compared with tenofovir (adjusted hazard ratio: 2.32, 95% confidence interval: 1.23 to 4.40); for patients on stavudine, the risk of a toxicity-driven regimen switch was almost 6 times higher than tenofovir (adjusted hazard ratio: 5.43, 95% confidence interval: 3.31 to 8.91).Our findings support the latest World Health Organization Guidelines, in particular the adoption of tenofovir in first line, given the advantages in terms of tolerability and availability as a once-daily formulation.
