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Efectividad a largo plazo y seguridad de la didanosina combinada con lamivudina y efavirenz o nevirapina en pacientes sin previo tratamiento con antirretrovirales: un estudio de cohortes durante 9 años en Senegal
Author(s) -
Laurent Christian,
Tchatchueng Mbougua Jules Brice,
Ngom Guèye Ndèye Fatou,
Etard JeanFrançois,
Diouf Assane,
Landman Roland,
Molinari Nicolas,
Girard PierreMarie,
Sow Papa Salif,
Ndoye Ibra,
Delaporte Eric
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02690.x
Subject(s) - nevirapine , efavirenz , lamivudine , didanosine , zidovudine , regimen , medicine , viral load , cohort , virology , viral disease , human immunodeficiency virus (hiv) , antiretroviral therapy , hepatitis b virus , virus
Summary Objective The use of didanosine (ddI) in first‐line antiretroviral therapy has been recently promoted for resource‐limited settings. We therefore compared the long‐term effectiveness and safety of the regimen combining ddI, lamivudine, and efavirenz or nevirapine with that of the WHO‐recommended regimen of zidovudine (ZDV), lamivudine, and efavirenz or nevirapine in antiretroviral‐naïve patients in Senegal. Methods Observational cohort study of patients enrolled between January 2000 and April 2002 in the Senegalese antiretroviral drug access initiative. Multivariate analyses were performed to compare, between the ddI and ZDV groups, the proportion of patients with a viral load <500 copies/ml during follow‐up; the increase in the CD4 cell count; survival; treatment changes and severe adverse events. Results Of 151 patients, 71 received the ddI‐based treatment and 80 received the ZDV‐based treatment. Throughout follow‐up, 80–95% of patients had a viral load below 500 copies/ml in both the ddI and ZDV groups ( P = 0.5). The CD4 cell count increased after treatment initiation from 176 to 497 cells/mm 3 in the ddI group and from 176 to 567 cells/mm 3 in the ZDV group ( P > 0.3). The rate of death tended to be higher in the ddI group ( P = 0.06). ddI was less commonly discontinued than ZDV ( P = 0.03). Conclusion The combination of ddI, lamivudine, and efavirenz or nevirapine resulted in sustained viral suppression and immunological recovery.