cART prescription trends in a prospective HIV cohort in rural Tanzania from 2007 to 2011

BMC Infectious Diseases

Manuel Battegay³  Marcel Tanner²  Christoph Hatz²  Daniel Nyogea¹  Tracy R Glass²  Boniphace Jullu¹  Geoffrey Mwaigomole¹  Emilio Letang²  Fabian Christoph Franzeck² 

[1]Ifakara Health Institute (IHI), Ifakara, United Republic of Tanzania

[2]University of Basel, Basel, Switzerland

[3]Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

关键词: AIDS;    HIV;    Stavudine;    Africa;    Combination;    Regimen;    cART;   

Others  :  1134546
DOI  :  10.1186/1471-2334-14-90

 received in 2013-06-19, accepted in 2014-02-18,  发布年份 2014

【 摘 要 】

Background

Since 2010, World Health Organization (WHO) guidelines discourage using stavudine in first-line regimens due to frequent and severe side effects. This study describes the implementation of this recommendation and trends in usage of antiretroviral therapy combinations in a cohort of HIV-positive patients in rural Tanzania.

Methods

We analyzed longitudinal, prospectively collected clinical data of HIV-1 infected adults initiating antiretroviral therapy within the Kilombero Ulanga Antiretroviral Cohort (KIULARCO) in Ifakara, Tanzania from 2007-2011.

Results

This analysis included data of 3008 patients. Median age was 38 (interquartile range [IQR] 31-45) years, 1962 (65.2%) of all subjects were female, and median CD4+ cell count at enrollment was 168 cells/mm³ (IQR 81-273). The percentage of prescriptions containing stavudine in initial regimens fell from a maximum of 75.3% in 2008 to 10.7% in 2011. TDF/FTC/EFV became available in 2009 and was used in 41.9% of patients initiating cART in 2011. An overall on-treatment analysis revealed that d4T/3TC/NVP and AZT/3TC/EFV were the most prescribed combinations in each year, including 2011 (674 [36.5%] and 641 [34.7%] patients, respectively). Of those receiving stavudine in 2011, 659 (89.1%) initiated it before 2011.

Conclusions

Initial cART with stavudine declined to low levels according to recommendations but the overall use of stavudine remained substantial, as individuals already on cART containing stavudine were not changed to alternative drugs. Our findings highlight the critical need to exchange stavudine in treatment regimens of patients who initiated therapy in earlier years.

【 授权许可】

   
2014 Franzeck et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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