Toxicity and clinical outcomes in patients with HIV on zidovudine and tenofovir based regimens: a retrospective cohort study.

Abstract

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 HIV-positive 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 (p=0.63) 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.

• Authors: Sowmyanarayanan V Thuppal, Christine A Wanke, Farzad Noubary, Joshua T Cohen, Mkaya Mwamburi, Abraham C Ooriapdickal, Jayaprakash Muliyil, Gagandeep Kang, George M Varghese, Priscilla Rupali, Rajiv Karthik, Rajkumar Sathasivam, Peace Clarance, Susanne A Pulimood, Dincy Peter, Leni George
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene (Trans R Soc Trop Med Hyg) Vol. 109 Issue 6 Pg. 379-85 (Jun 2015) ISSN: 1878-3503 [Electronic] England
• PMID: 25778734 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Anti-HIV Agents
• RNA, Viral
• Zidovudine
• Tenofovir

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• Female
• HIV Infections (blood, drug therapy)
• Humans
• India (epidemiology)
• Male
• Middle Aged
• RNA, Viral (blood)
• Retrospective Studies
• Tenofovir (therapeutic use)
• Treatment Outcome
• Viral Load (drug effects)
• Weight Gain (drug effects)
• Zidovudine (therapeutic use)