Stavudine Toxicity in Women is the Main Reason for Treatment Change in a 3-Year Prospective Cohort of Adult Patients Started on First-Line Antiretroviral Treatment in Uganda
Stavudine Toxicity in Women is the Main Reason for Treatment Change in a 3-Year Prospective Cohort of Adult Patients Started on First-Line Antiretroviral Treatment in Uganda
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DOI：
10.1097/qai.0b013e3181f5bd03
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发表时间：
2011-01-01
影响因子：
3.6
通讯作者：
Manabe, Yukari
中科院分区：
文献类型：
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作者：
Castelnuovo, Barbara;Kiragga, Agnes;Manabe, Yukari
目的：在资源有限的情况下，抗逆转录病毒治疗(ART)的选择很少。我们的目标是评估在资源有限的情况下一线抗逆转录病毒治疗改变的原因。方法：对2004年4月至2005年4月在乌干达坎帕拉启动抗逆转录病毒治疗的患者进行前瞻性研究。结果：559名接受抗逆转录病毒治疗的患者中，70%是女性，每微升CD_4+细胞数中位数为98(21-163)个，HIV-RNA LOG中位数(10)为5.4(5.0-5.8)。413名患者(74%)开始服用司他夫定、拉米夫定和奈韦拉平，146名患者(36%)开始服用齐多夫定、拉米夫定和依沙韦仑。148人(26.5%)至少有一次治疗改变(发病率为14.3‰；可信区间：12.2%~16.9%)。首次改变治疗的主要原因是药物毒性(n=91，61.5%)。司他夫定是导致药物替代的主要毒副作用(n=76，84%)。在多因素分析中，女性(P=0.011.0 5)和ART开始时的3-4期与1-2期相比预测司他夫定的替代(P=0.0 5)。由于毒性而改变的患者与没有改变的患者相比，病毒学结果没有差异。结论：大多数治疗改变是由于司他夫定相关的毒性。在女性中，长期使用司他夫定的耐受性较差。
Purpose: In resource-limited settings, there are only a few antiretroviral treatment (ART) options. Our objective was to evaluate the reasons for first-line ART changes in resource-limited settings.Methods: Prospective research cohort of patients initiating ART between April 2004 and April 2005 in Kampala, Uganda. The main endpoint was the substitution of at least 1 drug included in the initial combination.Results: Five hundred Fifty-nine patients initiated on ART, 70% were female, median CD4+ count 98 (21-163) cells per microliter, median HIV RNA log(10) 5.4 (5.0-5.8). 413 (74%) patients were started on stavudine, lamivudine, and nevirapine, and 146 (36%) on zidovudine, lamivudine and efavirenz. One hundred Forty-eight (26.5%) had at least one treatment change (incidence rate 14.3 per 100 person-years; confidence interval: 12.2 to 16.9). The main reason for first treatment change was drug toxicity (n = 91, 61.5%). Stavudine accounted for the majority of the toxicities that led to drug substitution (n = 76, 84%). In the multivariate analysis, being female (P = 0.011) and being stage 3-4 as compared with 1-2 at ART initiation were predictive of stavudine substitution (P = 0.05). There was no difference in virologic outcome in patients who changed due to toxicity compared with those who did not.Conclusions: The majority of the treatment changes were due to stavudine-related toxicity. Long-term stavudine use is less well tolerated in women.