Efficacy and Tolerability of Tenofovir Disoproxil Fumarate Based Regimen as Compared to Zidovudine Based Regimens: A Systematic Review and Meta-Analysis

Abstract

Background Although tenofovir (TDF)/emtricitabine (FTC)/efavirenz (EFV) and zidovudine (ZDV)/lamivudine (3TC)/efavirenz (EFV) are used as preferred first line regimen, their head-to-head comparison in terms of their efficacy and tolerability was limited. This review aimed to synthesize the best available evidence on the comparative efficacy and tolerability of the two regimens. Methods Seven sites and databases in addition to Google search until August 20, 2016, were searched. Only randomized clinical trials conducted on adult population were included in this study. Our primary outcome was viral load suppression while secondary outcomes were death and tolerability. Undetectable viral load is defined as <50 Human Immunodeficiency Virus (HIV) ribonucleic acid (RNA) copies/ml. Joanna Briggs institute meta-analysis of statistics assessment and review instrument (JBI-MAStARI) and critical appraisal and data extraction tool were applied for critical assessment and data extraction, respectively. We performed a random effect meta-analysis to pool the relative risk (RR) for viral load suppression (<50 HIV RNA copies/ml and <400 HIV RNA copies/ml), tolerability, and death. Result Data was extracted from four articles, which included a total of 2381 participants. We found superior viral load suppression among tenofovir (TDF) arm compared to zidovudine (ZDV) arm. Tenofovir arm achieves viral load <50 HIV RNA copies/ml (RR = 1.12, 95% confidence interval (CI) [1.04, 1.21], I2 = 0%) higher than zidovudine arm. Similarly TDF arm is superior in viral load suppression to <400 HIV RNA copies/ml (RR = 1.19, 95% CI [1.11, 1.27], I2 = 0%). Moreover, TDF based regimens were more likely to be tolerated than ZDV based regimens (4 trials, 2381 participants (RR = 1.06, 95% CI [1.02, 1.10], I2 = 51%)). However, forest plot of death shows that it was not significant (RR = 0.91, 95% CI [0.51, 1.62]). Conclusion The use of TDF/FTC/EFV as first line regimen for naïve HIV-1 infected adult patient showed superior viral load suppression and tolerability as compared to ZDV/3TC/EFV. In order to compare the death outcome of both ZDV/3TC/EFV and TDF/FTC/EFV further research is needed.

Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling

“…This might be because AZT-3TC-NVP is taken twice per day (drug burden) that results in the patient not taking the drug appropriately and end up with LTFU and also TDF-3TC-EFV is fixed-dose combinations of ART agents which helps to reduce dosing complexity [45]. Tenofovir regimen is claimed to have a better safety profile, even though it may result renal toxicity, compared to zidovudine because of a reduced incidence of anemia and fat redistribution [46][47][48][49][50], so patients with AZT-3TC-NVP may have a loss of hope on the medication if they become ill due to anemia and other complications and finally may be lost from HIV care [32].…”

Five-year trends in treatment changes in an adult cohort of HIV/AIDS patients in Ghana: a retrospective cohort study

“…Results from this study show that a tenofovir combination HAART (especially a combination with efavirenz) may have a slight edge over a zidovudine combination HAART. In a systematic review and meta-analysis, a tenofovir combination HAART showed superior viral load suppression, and was better tolerated by patients [ 24 ]. However, emtricitabine, instead of lamivudine was the supporting drug.…”

Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India

“…Zidovudine is an ARV which belongs to the class of nucleoside reverse transcriptase inhibitors (NRTIs). [3][4][5] However, both drugs are associated with side effects Both the regimens zidovudine and tenofovir are used as first line antiretroviral treatment (ART), although zidovudine is associated with side-effects such as chronic anemia, which are likely to affect patients' QoL (Quality of life). In case of Tenofovir it has a better safety profile compared to zidovudine, with the main side-effect being renal toxicity.…”

“…6 According to some studies tenofovir is superior to zidovudine in terms of its safety profile because of a reduced incidence of anemia and fat redistribution. 4,[7][8][9] Some other studies revealed that Tenofovir had fewer side effects, but the range of side-effects studied was limited. 10 There are limited data comparing ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz).…”