Effects of a reduced dose of stavudine on the incidence and severity of peripheral neuropathy in HIV-infected adults in South Africa
Effects of a reduced dose of stavudine on the incidence and severity of peripheral neuropathy in HIV-infected adults in South Africa
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DOI：
10.3851/imp2087
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发表时间：
2012-01-01
影响因子：
1.2
通讯作者：
Naidoo, Kogieleum
中科院分区：
文献类型：
--
作者：
Pahuja, Meera;Grobler, Anneke;Naidoo, Kogieleum
背景资料：尽管世界卫生组织（WHO）最近的指南建议从一线抗逆转录病毒治疗（ART）中撤出司他夫定（d4 T），但它仍然在资源有限的环境中常用。2006年，世卫组织建议将d4 T的剂量从40 mg降至30 mg，以减轻毒性。我们比较了周围神经病变的发病率和严重程度的d4 T剂量在一项回顾性队列study.Methods：患者的图表从ART初治人口在农村诊所在夸祖鲁-纳塔尔，南非，回顾性分析的体征和症状的事件周围神经病变和严重程度进行了分级，使用DAIDS量表。在WHO指南变更前入组的患者，如果接受d4 T 40 mg治疗≥ 6个月，则纳入研究。指南变更后，所有患者均开始接受d4 T 30 mg治疗。结果：共分析了475例患者，包括40 mg队列中的235例（152.7人-年[py]）和30 mg队列中的240例（244.7人-年[py]）。40 mg队列中周围神经病变的发生率为90.4/100 py（95% CI 75.9，106.8），而30 mg组为40.5/100 py（95% CI 32.9，49.3）（发生率比0.45; P
Background: Although recent World Health Organization (WHO) guidelines recommend withdrawing stavudine (d4T) from first-line antiretroviral therapy (ART), it remains commonly used in resource-limited settings. In 2006, WHO recommended decreasing the dose of d4T from 40 mg to 30 mg to mitigate toxicities. We compared the incidence and severity of peripheral neuropathy by d4T dose in a retrospective cohort study.Methods: Patients' charts from an ART-naive population at a rural clinic in KwaZulu-Natal, South Africa, were retrospectively reviewed for signs and symptoms of incident peripheral neuropathy and were graded for severity using the DAIDS scale. Patients enrolled prior to the WHO guideline change were included in the study if they were on d4T 40 mg for >= 6 months. After the guideline change all patients were initiated on d4T 30 mg.Results: A total of 475 patients were analysed, including 235 in the 40 mg cohort (152.7 person-years [py]) and 240 in the 30 mg cohort (244.7 py). Incidence of peripheral neuropathy was 90.4/100 py (95% CI 75.9, 106.8) in the 40 mg cohort versus 40.5/100 py (95% CI 32.9, 49.3) in the 30 mg group (incidence rate ratio 0.45; P