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Is zidovudine first‐line therapy virologically comparable to tenofovir in resource‐limited settings?
Author(s) -
Labhardt Niklaus D.,
Bader Joëlle,
Lejone Thabo Ismael,
Ringera Isaac,
Puga Daniel,
Glass Tracy R.,
Klimkait Thomas
Publication year - 2015
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.12509
Subject(s) - zidovudine , efavirenz , medicine , regimen , nevirapine , lamivudine , odds ratio , viral load , reverse transcriptase inhibitor , virology , human immunodeficiency virus (hiv) , antiretroviral therapy , virus , viral disease , hepatitis b virus
Objective To compare virologic success between adult patients on tenofovir ( TDF ) and zidovudine ( AZT )‐containing first‐line antiretroviral ( ART ) regimens in 10 rural clinics in Lesotho, Southern Africa. Methods Multicentre cross‐sectional study, patients ≥16 years, on first‐line ART ≥6 months, receiving AZT/lamivudine (3TC) or TDF/3TC combined with efavirenz (EFV) or nevirapine (NVP). Patient characteristics and clinical/therapeutic history were collected on the day of blood draw for viral load (VL). Analysis was stratified for non‐nucleoside reverse transcriptase inhibitor (EFV or NVP). A logistic regression model weighted for patients' baseline characteristics was used to assess the likelihood of virologic success (<80 copies/ml) in patients with TDF‐ as compared to AZT‐backbones. Results In total 1539 patients were included in the analysis. Most were clinically and immunologically stable (clinical failure: 2.7% ( AZT ) and 2.8% ( TDF ); immunological failure: 4.6% ( AZT ) and 4.8% ( TDF )). In EFV ‐based regimens ( n = 1162), TDF was significantly associated with higher rates of virologic suppression than AZT (93.8% vs . 88.1%; weighted odds ratio: 2.15 (95% CI : 1.29–3.58; P = 0.003)). In NVP ‐based regimens, a similar trend was observed, but not significant (89.4% vs . 86.7%; 1.99 (0.83–4.75, P = 0.121)). Conclusion These findings support the WHO recommendation to use TDF /3 TC / EFV as first‐line regimen. They do, however, not support the recommendation that patients who are clinically stable on AZT should continue on this first‐line regimen.