Durability of initial antiretroviral therapy in a resource-constrained setting and the potential need for zidovudine weight-based dosing

Journal of Acquired Immune Deficiency Syndromes : JAIDS
James H WilligEduardo Gotuzzo

Abstract

Whereas access to antiretroviral therapy (ART) for HIV-infected individuals in the developing world is increasing, data on factors impacting initial regimen durability are lacking. Retrospective review patients starting initial ART at Instituto de Medicine Tropical (Lima, Peru) April 1, 2004 to December 30, 2007. Survival methods (Kaplan-Meier, Cox proportional hazard) assessed factors associated with regimen durability including an interaction term between nucleoside reverse transcriptase inhibitor backbone and time. Decreased initial regimen durability was observed with weight <60 kg [hazards ratio (HR) = 1.77; 95% confidence interval (CI) = 1.25-2.51], CD4 <200 (HR = 1.73; 95% CI = 1.03-2.91), and zidovudine (AZT) use at <120 days (HR = 2.09; 95% CI = 1.22-3.57). In contrast, after 120 days, AZT use decreased risk of discontinuation (HR = 0.52; 95% CI = 0.28-0.95). Early (<120 days) toxicity-related discontinuation of AZT containing regimens was observed in 44% of patients <50 kg at baseline vs. 14% of those >70 kg. An increased risk of early toxicity-related discontinuation of AZT-containing regimens was observed for baseline weight <60 kg (HR = 2.52; 95% CI = 1.46-4.35). Lower baseline weight and lower CD4 values at ART in...Continue Reading

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Citations

Feb 24, 2011·AIDS Research and Human Retroviruses·Christa R NevinJames H Willig
Nov 16, 2012·AIDS Research and Human Retroviruses·James H WilligTimothy Juday
Jul 10, 2009·Current Opinion in Oncology·Joel M Palefsky
Feb 2, 2011·F1000 Medicine Reports·Thomas Newsom-Davis, Mark Bower
Feb 9, 2012·The Indian Journal of Medical Research·N KumarasamySanjay Pujari
Sep 27, 2020·International Journal of Colorectal Disease·Danielle R L BrogdenSarah C Mills
Sep 16, 2015·AIDS·Bohdan NosykUNKNOWN STOP HIVAIDS Study Group
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Mar 4, 2017·World Journal of Gastrointestinal Oncology·Joseph R RobertsAndrew M Kaz
Apr 17, 2012·International Journal of Hepatology·Manuela G NeumanCharles Parry

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