Document Detail

Stavudine toxicity in women is the main reason for treatment change in a 3-year prospective cohort of adult patients started on first-line antiretroviral treatment in Uganda.
MedLine Citation:
PMID:  20861741     Owner:  NLM     Status:  MEDLINE    
PURPOSE: In resource-limited settings, there are only a few antiretroviral treatment (ART) options. Our objective was to evaluate the reasons for first-line ART changes in resource-limited settings.
METHODS: Prospective research cohort of patients initiating ART between April 2004 and April 2005 in Kampala, Uganda. The main endpoint was the substitution of at least 1 drug included in the initial combination.
RESULTS: Five hundred Fifty-nine patients initiated on ART, 70% were female, median CD4+ count 98 (21-163) cells per microliter, median HIV RNA log₁₀ 5.4 (5.0-5.8). 413 (74%) patients were started on stavudine, lamivudine, and nevirapine, and 146 (36%) on zidovudine, lamivudine and efavirenz. One hundred Forty-eight (26.5%) had at least one treatment change (incidence rate 14.3 per 100 person-years; confidence interval: 12.2 to 16.9). The main reason for first treatment change was drug toxicity (n = 91, 61.5%). Stavudine accounted for the majority of the toxicities that led to drug substitution (n = 76, 84%). In the multivariate analysis, being female (P = 0.011) and being stage 3-4 as compared with 1-2 at ART initiation were predictive of stavudine substitution (P = 0.05). There was no difference in virologic outcome in patients who changed due to toxicity compared with those who did not.
CONCLUSIONS: The majority of the treatment changes were due to stavudine-related toxicity. Long-term stavudine use is less well tolerated in women.
Barbara Castelnuovo; Agnes Kiragga; Moses R Kamya; Yukari Manabe
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  56     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-01-11     Revised Date:  2014-02-06    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  59-63     Citation Subset:  IM; X    
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MeSH Terms
Anti-HIV Agents / administration & dosage,  adverse effects*,  therapeutic use
Antiretroviral Therapy, Highly Active / adverse effects
Benzoxazines / administration & dosage,  therapeutic use
HIV Infections / drug therapy*
Kaplan-Meier Estimate
Lamivudine / administration & dosage,  therapeutic use
Multivariate Analysis
Nevirapine / administration & dosage,  therapeutic use
Prospective Studies
Risk Factors
Sex Factors
Stavudine / administration & dosage,  adverse effects*,  therapeutic use
Uganda / epidemiology
Zidovudine / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Anti-HIV Agents; 0/Benzoxazines; 2T8Q726O95/Lamivudine; 4B9XT59T7S/Zidovudine; 99DK7FVK1H/Nevirapine; BO9LE4QFZF/Stavudine; JE6H2O27P8/efavirenz

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