Tolerability
and Effectiveness of First-line Treatment with Nevirapine and Lamivudine plus
Zidovudine or Stavudine
 | Viramune
Tablet |  | Epivir
Tablet |  | Retrovir
Tablet |
Though
it has fallen out of favor in industrialized countries due to toxicities such
as mitochondrial toxicity and lipoatrophy, stavudine (d4T;
Zerit) is still commonly used in resource-limited settings due to its low
cost and widespread availability.In
the current study, published in the March 1 issue of AIDS Research and Human
Retroviruses, researchers compared the tolerability and effectiveness of 2
major first-line regimens used for the treatment of HIV in resource-limited settings:
nevirapine (Viramune) and lamivudine
(3TC; Epivir) plus either stavudine
or zidovudine (AZT; Retrovir).
This prospective
cohort study, conducted between 2001 and 2003, enrolled 169 adult patients in
Cameroon, Africa. Eligible participants were treatment-naive and had AIDS or a
CD4 cell count below 350 cells/mm3, a Karnofsky score over 50%, and no contraindications
to antiretroviral therapy. Half
the patients (n = 85) received zidovudine/lamivudine/nevirapine and the rest (n
= 84) received stavudine/lamivudine/nevirapine. Participants were followed for
up to 2 years.  Results
•
The
rates of treatment change were 12.0 and 10.9 per 100 person-years, respectively,
in the zidovudine- and stavudine-containing arms.
•
Rates
of death were 5.7 and 7.6 per 100 person-years, respectively.
•
The
rates of drug resistance were in 2.9 and 5.0 per 100 person-years, respectively.
•
The
incidence rates of severe adverse effects were 41.7 and 49.1 per 100 person-years,
respectively.
•
The
Kaplan-Meier curves for the likelihood of remaining on the initial regimen (P
= 0.8) and for survival (P = 0.5) did not differ significantly between the 2 groups.
•
Only
a lower baseline CD4 cell count was associated with death (P < 0.001).
•
The
proportions of patients with undetectable viral load and increases in the CD4
cell count were similar in the 2 groups.
•
Anemia
was rare overall (4% vs 6% in the zidovudine and stavudine groups).
•
5
cases of severe peripheral neuropathy and 1 case of lipodystrophy occurred.
Conclusion In
conclusion, the study authors wrote, "This study suggests that the zidovudine/lamivudine/nevirapine
combination is a safe first-line treatment, even in settings with few laboratory
resources." Further,
they stated, "In view of stavudine toxicity, these results support recommendations
calling for a gradual switch from stavudine- to zidovudine-based regimens." 4/29/08 Reference
C Laurent, A Bourgeois, E Mpoudi-Ngole, and others. Tolerability and
Effectiveness of First-Line Regimens Combining Nevirapine and Lamivudine Plus
Zidovudine or Stavudine in Cameroon. AIDS Research and Human Retroviruses
24(3): 393-400. March 1, 2008. | 
