Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?

By  Alana Brennan  Mary-Ann Davies  Jacob Bor  Gilles Wandeler  Kathryn Stinson  Robin Wood  Hans Prozesky  Frank Tanser  Geoffrey Fatti, Andrew Boulle, Izukanji Sikazwe, Kara Wool-Kaloustian, Constantin Yiannoutsos, Vale´riane Leroy, Nathalie de Rekeneire  Matthew Fox  |  | 

Objective: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first line ART) in sub-Saharan Africa.
Design: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005 and December 2012. Before April 2010 (July 2007 in Zambia) national guidelines called for patients to initiate stavudine-based or zidovudine-based regimen, whereas thereafter tenofovir or zidovudine replaced stavudine in first-line ART.
Methods: We evaluated the frequency of stavudine use and SDS by calendar year  2004–2014. Competing risk regression was used to assess the association between nucleoside reverse transcriptase inhibitor use and SDS in the first 24 months on ART.
Results: In all, 33 441 (8.9%; 95% confience interval 8.7–8.9%) SDS occurred among 377 656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in SDS corresponded with the phasing out of stavudine. Competing risks regression models showed that patients on tenofovir were 20–95% less likely to require a SDS than patients on stavudine, whereas patients on zidovudine had a 75–85% decrease in the hazards of SDS when compared to stavudine.

Publication details

AIDS
#
2016
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https://www.ncbi.nlm.nih.gov/pubmed/27776039