Stavudine,
Lamivudine and Nevirapine Is Maintained Longer than Other First-line Regimens
in a Large Asian Cohort
In
a growing number of Asian countries, the first-line antiretroviral drug combination
most often used is stavudine (Zerit),
lamivudine (Epivir) and nevirapine
(Viramune) [d4T/3TC/NVP]. However, there are scant published data on use of
this regimen in Asian clinic cohorts.
In the current study, researchers
evaluated outcomes in patients from the TREAT Asia HIV Observational Database
(TAHOD) who started their first ART regimen with d4T/3TC/NVP.
Treatment
change was defined as cessation of therapy or the addition or change of one or
more drugs. Clinical failure was defined as diagnosis with an AIDS-defining
illness, or death while on d4T/3TC/NVP treatment.
Results
•The rate of treatment change
among TAHOD patients starting d4T/3TC/NVP as their first antiretroviral treatment
was 22.3 per 100 person-years, with lower baseline hemoglobin (i.e. anemia)
associated with slower rate of treatment change.
•The
rate of clinical failure while on d4T/3TC/NVP treatment was 7.3 per 100 person-years,
with baseline CD4 cell count significantly associated with clinical failure.
•After
d4T/3TC/NVP was stopped, nearly 40% of patients did not restart any treatment
and, of those who changed to other treatment, the majority changed to zidovudine
(ZDV)/3TC/NVP and less than 3% of patients changed to a protease
inhibitor (PI)-containing regimen.
•
The rates of disease progression on the second-line regimen were similar to those
on the first-line regimen.
The
authors conclude, "These real-life data provide an insight into clinical
practice in Asia and the Pacific region. d4T/3TC/NVP is maintained longer than
other first-line regimens and change is mainly as a result of adverse effects
rather than clinical failure.
"There is a need to develop affordable
second-line antiretroviral treatment options for patients with HIV infection in
developing countries."
1/19/07
Reference
J Zhou, N I Paton, R Ditangco, and others (the TREAT Asia HIV Observational
Database). Experience with the use of a first-line regimen of stavudine, lamivudine
and nevirapine in patients in the TREAT Asia HIV Observational Database. HIV
Medicine 8(1). Epub doi:10.1111/j.1468-1293.2007.00417.x January 2007.
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