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Changing utilization of Stavudine (d4T) in HIV‐positive people in 2006–2013 in the EuroSIDA study
Author(s) -
Podlekareva D,
Grint D,
Karpov I,
Rakmanova A,
Mansinho K,
Chentsova N,
Zeltina I,
Losso M,
Parczewski M,
Lundgren JD,
Mocroft A,
Kirk O
Publication year - 2015
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12254
Subject(s) - stavudine , medicine , poisson regression , confidence interval , rate ratio , cart , incidence (geometry) , human immunodeficiency virus (hiv) , demography , antiretroviral therapy , immunology , viral load , population , environmental health , mechanical engineering , sociology , engineering , physics , optics
Objectives The long‐term side effects of stavudine (d4 T ) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe. Methods Patients taking combination antiretroviral therapy ( cART ) in EuroSIDA with follow‐up after 1 J anuary 2006 were included in the study. cART was defined as d4T ‐containing [ d4T plus at least two other antiretrovirals ( ARVs ) from any class] or non‐ d4T ‐containing (at least three ARVs from any class, excluding d4T ). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T . Results A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval ( CI ) 19–20%]. d4T use declined fastest in N orthern E urope [26% (95% CI 23–29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16–19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio ( aIRR ) 0.86; 95% CI 0.80–0.91]. Factors associated with initiating d4T were residence in E astern E urope ( aIRR 4.31; 95% CI 2.17–9.98) versus other European regions and HIV RNA > 400 copies/mL ( aIRR 3.11; 95% CI 1.60–6.02) versus HIV RNA < 400 copies/mL. Conclusions d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in E astern E urope, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV ‐positive patients are aware of the potential harmful effects associated with d4T.