Tenofovir or Zidovudine in Second-Line Antiretroviral Therapy after Stavudine Failure in Southern Africa

Abstract

Background There is debate over using tenofovir or zidovudine alongside lamivudine in second-line antiretroviral therapy (ART) following stavudine failure. We analyzed outcomes in cohorts from South Africa, Zambia and Zimbabwe Methods Patients aged ≥16 years who switched from a first-line regimen including stavudine to a ritonavir-boosted lopinavir-based second-line regimen with lamivudine or emtricitabine and zidovudine or tenofovir in seven ART programs in southern Africa were included. We estimated the causal effect of receiving tenofovir or zidovudine on mortality and virological failure using Cox proportional hazards marginal structural models. Its parameters were estimated using inverse probability of treatment weights. Baseline characteristics were age, sex, calendar year and country. CD4 cell count, creatinine and hemoglobin levels were included as time-dependent confounders. Results 1,256 patients on second-line ART, including 958 on tenofovir, were analyzed. Patients on tenofovir were more likely to have switched to second-line ART in recent years, spent more time on first-line ART (33 vs. 24 months) and had lower CD4 cell counts (172 vs. 341 cells/μl) at initiation of second-line ART. The adjusted hazard ratio comparing tenofovir with zidovudine was 1.00 (95% confidence interval 0.59-1.68) for virologic failure and 1.40 (0.57-3.41) for death. Conclusions We did not find any difference in treatment outcomes between patients on tenofovir or zidovudine; however, the precision of our estimates was limited. There is an urgent need for randomized trials to inform second-line ART strategies in resource-limited settings.

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Comparison of Treatment Outcomes among Second-Line Antiretroviral Regimens in HIV/AIDS Patient

“…Selain karena toksisitasnya yang rendah, keduanya juga menunjukkan efikasi yang sebanding 21 . Tidak ada perbedaan signifikan dalam hal respon imunologis, kegagalan virologis, dan kematian antara rejimen ARV lini kedua berbasis tenofovir dan zidovudin pada rejimen ARV lini kedua 22 . Lamivudin dan emtricitabin ekuivalen secara klinis dan dapat saling menggantikan sehingga direkomendasikan oleh WHO menjadi komponen inti dari rejimen ARV lini pertama dan kedua 23 .…”

The impact of data quality and source data verification on epidemiologic inference: a practical application using HIV observational data

“…For example, we have pooled data from multiple HIV clinical care sites to better understand outcomes of key populations (e.g., late ART initiators [10], older patients [11], and patients with 10+ years of follow-up [12]) as well as assess site-level progress in clinical retention, ART use, and viral suppression over time [13]. Other HIV cohorts have investigated a myriad of topics, including (but not limited to) efficacy and tolerability of ART regimens [14], comorbidities [15] and patient outcomes [16]. Findings from these investigations are communicated with researchers, local care providers, regional stakeholders, and global non-governmental organizations, and often influence public health policy decisions.…”