Tenofovir-Based Highly Active Antiretroviral Therapy Is Associated with Superior CD4 T Cells Repopulation Compared to Zidovudine-Based HAART in HIV 1 Infected Adults (original) (raw)
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Journal of AIDS and HIV Research, 2020
Tenofovir-based regimen is the preferred first line treatment in Ethiopia despite limited local data on its effectiveness and tolerability over zidovudine-based regimen. Therefore, this study compared the outcomes of tenofovir and zidovudine-based regimens focusing on toxicity driven regimen substitution and mortality. A retrospective cohort study was conducted in Zewditu Memorial Hospital. All ART naïve patients who started ART between August 31, 2010, and August 31, 2013, were included. Data were collected by reviewing of patient's medical records. Kaplan-Meier test and Cox regression analysis were used to compare survival for toxicity driven substitution and mortality, and to identify the independent predictors respectively. A total of 223 patients were included in this study, among which 164 (73.5%) TDF and 59 (26.6%) AZT-based regimens. A total of 71 (31.8%) primary outcomes such as toxicity driven regimen substitution, mortality, and lost to follow-up were observed, 48(29.3%) among TDF and 23(39.0%) in AZT-based regimens. The risk of toxicity driven regimen substitution was more than five times higher in AZT than TDF group (AHR=5.07, p=0.013). The estimated cumulative mortality at 6, 12, 18 and 24 months was 6, 9, 9 and 9% in TDF group whereas it was 9, 13, 13, and 13% in AZT group. There was no statistically significant difference in mortality and regimen failure between TDF and AZT groups. TDF-based regimen has superior outcome and better survival for toxicity driven regimen change than AZT-based regimen. This study finding supports recommendation of TDF-based regimen as preferred first-line ART.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2015
Background: Adverse drug reactions are a major concern with zidovudine/stavudine treatment regimens. The less toxic tenofovir regimen is an alternative, but is seldom considered due to the higher costs. This study compared adverse drug reactions and other clinical outcomes resulting from the use of these two treatment regimens in India. Methods: Baseline, clinical characteristics and follow-up outcomes were collected by chart reviews of HIVpositive adults and compared using univariate/multivariate analysis, with and without propensity score adjustments. Results: Data were collected from 129 and 92 patients on zidovudine (with lamivudine and nevirapine) and tenofovir (with emtricitabine and efavirenz) regimens, respectively. Compared to patients receiving the zidovudine regimen, patients receiving the tenofovir regimen had fewer adverse drug reactions (47%, 61/129 vs 11%, 10/92; p,0.01), requiring fewer regimen changes (36%, 47/129 vs 3%, 3/92; p0.01). With the propensity score, the zidovudine regimen had 8 times more adverse drug reactions (p,0.01). Opportunistic infections were similar between regimens without propensity score, while the zidovudine regimen had 1.2 times (p¼0.63) more opportunistic infections with propensity score. Patients on the tenofovir regimen gained more weight. Increase in CD4 levels and treatment adherence (.95%) was similar across regimens. Conclusions: Patients on a tenofovir regimen have better clinical outcomes and improved general health than patients on the zidovudine regimen.
Journal of Clinical Virology, 2006
Background: HIV-1 nucleoside/tide reverse transcriptase inhibitors (NRTI)-only based, comprising tenofovir DF(TDF) have been shown to lead to high rates of virological failures (VF), mainly in patients on first-line combination therapy. We wished to investigate the virological response to these regimens in a large cohort of antiretroviral (ARV)-treated patients. Methods: Patients followed-up in the Aquitaine Cohort in 2001-2003 and who had received NRTI-based, TDF-including regimens for at least 3 months were included. The VF was defined as: (i) a decrease in plasma HIV-1 RNA <0.5 log 10 copies/ml between M0 and M3; or (ii) a plasma HIV-1 RNA >50 copies/ml at M3 in patients with plasma HIV-1 RNA <50 copies/ml at M0. The baseline RT genotype was determined in a subgroup of patients. Results: Within 121 patients (95% ARV-experienced) who received either lamivudine (3TC)/didanosine (DDI)/TDF (n = 48), or abacavir (ABC)/3TC/TDF (n = 14), or 3TC/zidovudine (ZDV)/TDF (n = 27), or 3TC/ZDV/ABC/TDF (n = 20), or DDI/ABC/TDF (n = 12), the ABC/3TC/TDF and DDI/ABC/TDF combinations were associated with the highest frequencies of VF. In contrast the use of ZDV was related to a better virological response. The baseline RT genotype was also predictive of the virological outcome. Conclusion: NRTI-based, TDF-including therapies can lead to high rates of VF both in ARV-naïve and in ARV-experienced patients. Our data strongly suggest the interest of associating ZDV and TDF in these regimens.
Clinical Infectious Diseases, 2005
We have recently reported that HIV-infected patients receiving combinations containing both the nucleotide reverse-transcriptase inhibitor (NRTI) tenofovir disoproxil fumarate (TDF) (300 mg/day) and full dosages (400 mg/day in patients weighing у60 kg and a reduced dosage of 250 mg/day in patients weighing !60 kg) of the NRTI didanosine (ddI) experience unexpected decreases in CD4 + cell count, despite maintaining undetectable plasma viral loads [1]. At 48 weeks, 150% of the 302 patients in this study showed a decrease of 1100 CD4 + cells/mm 3 , and up to 30% had a decrease of 1200 cells/mm 3 . This finding is further supported by a recent retrospective analysis of patients with controlled viremia . Patients receiving both ddI and TDF had a significant decline in CD4 + cell count over a 1-year treatment period, compared with those who took either drug alone or neither drug.
PLoS ONE, 2013
Background: Tenofovir (TDF) is part of the WHO recommended first-line antiretroviral therapy (ART); however, there are limited data comparing TDF to other nucleoside reverse transcriptase inhibitors in resource-limited-settings. Using a routine workplace and community-based ART cohort in South Africa, we assessed single drug substitution, HIV RNA suppression, CD4 count increase, loss-from-care, and mortality between TDF, stavudine (d4T) 30 mg dose, and zidovudine (AZT). Methods: In a prospective cohort study we included ART naïve patients aged $17 years-old who initiated ART containing TDF, d4T, or AZT between 2007 and 2009. For analysis of single drug substitutions we used a competing-risks time-to-event analysis; for loss-from-care, mixed-effect Poisson modeling; for HIV RNA suppression, competing-risks logistic regression; for CD4 count slope, mixed-effects linear regression; and for mortality, proportional hazards modeling. Results: Of 6,196 patients, the initial drug was TDF for 665 (11%), d4T for 4,179 (68%), and AZT for 1,352 (22%). During the first 6 months of ART, the adjusted hazard ratio for a single drug substitution was 2.3 for d4T (95% confidence interval [CI]: 0.27, 19) and 5.2 for AZT (95% CI: 1.1, 23), compared to TDF; whereas, after 6 months, it was 10 (95% CI: 5.8, 18) and 4.4 (95% CI: 2.5, 7.8) for d4T and AZT, respectively. Virologic suppression was similar by agent; however, CD4 count rise was lowest for AZT. The adjusted hazard ratio for loss-from-care, when compared to TDF, was 1.5 (95% CI: 1.1, 1.9) for d4T and 1.2 (95% CI: 1.1, 1.4) for AZT. The adjusted hazard ratio for mortality, when compared to TDF, was 2.7 (95% CI: 2.0, 3.5) and 1.4 (95% CI: 1.3, 1.5) and for d4T and AZT, respectively. Discussion: In routine care, TDF appeared to perform better than either d4T or AZT, most notably with less drug substitution and mortality than for either other agent.
2020
Introduction: India has a huge burden of HIV/AIDS infection. Tenofovir based rst line therapy is the preferred treatment for newly diagnosed cases with HIV infection. Methodology: The present prospective study was done among newly diagnosed cases of HIV infection. The patients were followed up for a period of 6 months from the day of enrolment. Sociodemographic parameters, CD4 counts and adverse drug reactions were analysed at baseline and after 6 months. Bivariate and multi-variate logistic regression was performed with the outcome variable as occurrence of adverse drug reactions. Result: In this study, 67 patients were enrolled with mean age 32.75 (± 14.39) years. Mean CD4 count at start of treatment was 241.5/mm3. Mean difference in CD4 count was 383.05/mm3 (SD = 274.9). Dizziness, tingling, numbness of extremities and muscle cramps were most common adverse effects. On multi-variate logistic regression, occurrence of ADRs was seen to be signi cantly higher only in illiterate patients. Conclusion: The present study highlights the importance of long-term follow-up of the patients on antiretroviral therapy. Adequate monitoring of the treatment parameters is of utmost importance. Introduction: Globally about 37.9 million [32.7-44.0 million] people were living with HIV in 2018. An estimated 0.8% [0.6-0.9%] of adults aged 15-49 years are living with HIV/AIDS worldwide. In 2018, about 1.7 million people were infected with HIV/AIDS indicating the continuous burden of the disease is a global concern. In India, the burden of HIV/AIDS is constant in recent times. As per India HIV Estimation 2017 report, prevalence among adults of 15-49 years is estimated at 0.22% (0.16%-0.30%) in 2017. The adult HIV prevalence in India had its steady decline from 0.38% in 2001-03 through 0.34% in 2007, 0.28% in 2012 and 0.26% in 2015 to 0.22% in 2017. Highly Active Antiretroviral therapy (HAART) forms the cornerstone of treatment of HIV infection. Tenofovir disoproxil fumarate (TDF) + Lamivudine (3TC) + Efavirenz (EFV) combination was the preferred rst-line antiretroviral therapy (ART) regimen for adults and adolescents according to WHO. , It has been implemented in India by National AIDS Control Organisation (NACO). Tenofovir disoproxil is a nucleotide analog reverse-transcriptase inhibitor (NtRTI). Lamivudine, a nucleoside analog, is a potent reverse transcriptase inhibitor. Efavirenz is classi ed as a non-nucleoside reverse-transcriptase inhibitor. Once daily Tenofovir based rst line regimen has better compliance and has improved adverse drug reaction pro le as compared to Zidovudine or Stavudine based therapy. As TLE is categorised as the rst line therapy in PLHIV, we intended to assess the adverse drug reactions in patients started on this regimen. The objectives of the present study were to assess adverse drug
The open AIDS journal, 2017
Tenofovir (TDF) based regimen is one of the first line agents that has been utilized routinely since 2013 in Ethiopia. Unfortunately, there is limited information regarding the Clinical outcomes and associated risk factors in this setting, where patients generally present late, have high rates of TB and other infectious conditions. A two year retrospective cohort study was conducted from February 10/2015 to March 10/2015 at Jimma University Specialized Hospital. A total of 280 records were reviewed by including data from September 3, 2012 to July 31, 2014. Records were selected using a simple random sampling technique. Data was collected on socio-demographic, clinical and drug related variables. Data was analyzed using STATA 13.1. Kaplan-Meier and Cox regression were used to compare survival experience and identify independent predictors. Propensity score matching analysis was conducted to elucidate the average treatment effects of each regimen over opportunistic infections. Of 280 ...