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Impact of choice of NRTI in first‐line antiretroviral therapy: a cohort analysis of stavudine vs . tenofovir
Author(s) -
Brennan Alana T.,
Shearer Kate,
Maskew Mhairi,
Long Lawrence,
Sanne Ian,
Fox Matthew P.
Publication year - 2014
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/tmi.12285
Subject(s) - stavudine , tenofovir , medicine , proportional hazards model , antiretroviral therapy , cohort , prospective cohort study , human immunodeficiency virus (hiv) , virology , viral load
Objective In A pril 2010, S outh A frica replaced stavudine with tenofovir in first‐line antiretroviral therapy ( ART ) despite tenofovir's higher cost. We examined treatment outcomes over 24 months amongst patients initiated on tenofovir‐based vs . stavudine‐based first‐line regimens. Methods Prospective cohort analysis of 3940 patients newly initiating either stavudine‐based ( A pril 2009 to M arch 2010) or tenofovir‐based ( A pril 2010 to M arch 2011) ART in J ohannesburg, S outh A frica. Cox proportional hazards models and F ine and G ray's competing risk regression accounting for death were used to model mortality and loss to follow‐up, respectively. Linear and log‐binomial regression were used to evaluate associations with immunologic response and unsuppressed virus (≥400 copies/ml), respectively. Results About 1878 patients prescribed tenofovir and 2062 patients prescribed stavudine were included. One hundred and sixty‐six (8.8%) tenofovir and 244 (11.8%) stavudine patients died. Three hundred and fifty (18.6%) tenofovir and 379 (18.4%) stavudine patients were lost to follow‐up over 24 months on ART . Adjusted regression models showed tenofovir and stavudine were comparable regarding death, loss to follow‐up, immunologic response and virologic status. Conclusions We found no difference in mortality, loss to follow‐up, immunological and virologic outcomes over the first 24‐months on ART associated with tenofovir compared with stavudine.