Premium
Impact of long‐term treatment with neurotoxic dideoxynucleoside antiretrovirals: implications for clinical care in resource‐limited settings
Author(s) -
Hung CF,
Gibson SA,
Letendre SL,
Lonergan JT,
MarquieBeck JA,
Vaida F,
Ellis RJ
Publication year - 2008
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/j.1468-1293.2008.00615.x
Subject(s) - medicine , didanosine , stavudine , regimen , drug , confidence interval , cohort , hazard ratio , intensive care medicine , antiretroviral therapy , viral load , human immunodeficiency virus (hiv) , pharmacology , immunology
Objectives A minority of HIV‐infected patients taking an antiretroviral (ARV) regimen containing dideoxynucleosides (d‐drugs) such as stavudine (d4T) and didanosine (DDI) experiences dose‐limiting neuropathic pain and paraesthesias, usually within weeks of starting these drugs. Because d‐drugs are among the few affordable options available in developing countries, continuing d‐drug therapy would be a desirable strategy for many HIV‐infected individuals. Therefore, we evaluated the safety of continuing d‐drug therapy. Methods In a US cohort, we compared the rates of worsening neuropathic symptoms and signs in HIV‐infected individuals on stable ARV regimens that did ( n =252) or did not ( n =250) include d‐drugs. Rates of worsening were compared using proportional hazards model and the log‐rank test. Results The risk ratios (RR) were not significantly larger for worsening neuropathy signs [0.94; 95% confidence interval (CI) 0.84–1.07] or symptoms (0.99; 95% CI 0.88–1.14) in patients taking d‐drugs continuously compared to those not taking d‐drugs. Conclusions Continued d‐drug exposure among patients tolerating an initial trial did not increase the risk of worsening neuropathy compared to non‐d‐drug‐containing regimens. If applicable in developing countries, these findings suggest that in most patients d‐drugs can be continued safely in the long term without increasing the risk of worsening neuropathy.