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Implementing a tenofovir-based first-line regimen in rural Lesotho: clinical outcomes and toxicities after two years | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Implementing a tenofovir-based first-line regimen in rural Lesotho: clinical outcomes and toxicities after two years

Bygrave H, Ford NP, van Cutsem G, Hilderbrand K, Jouquet G, Goemaere E, Vlahakis N, Trivino L, Makakole L, Kranzer K
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Abstract
BACKGROUND
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.

METHODS
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.

RESULTS
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).

CONCLUSIONS
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.

Countries

Lesotho

Subject Area

HIV/AIDS

Languages

English
DOI
10.1097/QAI.0b013e3182097505
Published Date
01 Mar 2011
PubMed ID
21164354
Journal
Journal of Acquired Immune Deficiency Syndromes (JAIDS)
Volume | Issue | Pages
Volume 56, Issue 3, Pages e75-e78
Issue Date
2011-03-01
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