Is it Time to Abandon Stavudine? The Safety and Tolerability of Low Dose Stavudine versus Zidovudine in Urban Kenya
Date
2013Author
Ogola, Beatrice A
Oluka, Margaret O
Osanjo, George O
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Background:
Stavudine (d4T) and zidovudine (AZT) form the backb
one of the most commonly used first-line highly
active antiretroviral therapy (HAART) regimens in K
enya. In 2012, more than 60 % of patients undergoin
g
combination antiretroviral therapy were either on A
ZT or d4T based regimens, mainly due to their affor
dability and
availability in fixed dose combinations. Following,
the World health Organization’s recommendation in
2010 that d4T
should be phased out due to safety concerns, Kenya
has been steadily withdrawing d4T from HIV/AIDS tre
atment
programmes. Despite these decisions, questions as t
o whether stavudine ought to be altogether abandone
d in
resource constrained settings continue to elicit de
bate among clinicians, researchers and patient grou
ps.
Objective:
This study was consequently designed to compare the
tolerability and efficacy of AZT with low dose d4T
in
treatment of HIV infected adults in urban Kenya, an
d to generate data on the safety of low dose stavud
ine.
Method:
The design was an analytic retrospective hospital-
based cohort study that involved examination of rec
ords
of patients on antiretroviral therapy. The study ha
d two comparator arms: (i) ART-naive adult patient
s initiated on
stavudine 30 mg based HAART, and (ii) ART-naive adu
lt patients initiated on zidovudine based HAART. Qu
antitative
variables were described with medians or means, and
compared between groups using Wilcoxon rank sum te
st.
Association effects were determined by use of Chi-s
quare test. Categorical variables were summarized
using
proportions. The time to event analysis was estima
ted using the Kaplan–Meier product limit method. Co
x
Proportional Hazards regression was used to model t
he hazard rates of regimen switching.
Results:
The incidence rate (IR) of switching regimen was hi
gher in patients initiated on zidovudine than in pa
tients
initiated on low dose stavudine (11.3 % and 7.0 % r
espectively). The most common reason for regimen sw
itch was
toxicity (79.2 %). In patients initiated on stavudi
ne, lipodystrophy was the main reason for treatment
change (53.2 %)
followed by peripheral neuropathy (23.4 %). Amongst
patients initiated on zidovudine, anaemia was the
main reason
for treatment change (33.3 %). There was no signifi
cant difference in median change in CD4 cell counts
between the
two treatment groups.
Conclusion:
The study has showed that patients initiated on a z
idovudine based regimen were more likely to change
their treatment compared to those on a low dose sta
vudine. Stavudine therefore still has its benefits,
and public health
programmes should not altogether abandon it.
URI
http://journals.uonbi.ac.ke/files/journals/5/articles/1135/submission/review/1135-4125-1-RV.pdfhttp://hdl.handle.net/11295/64905
Citation
Ogola, B. A., Oluka, M. O., & Osanjo, G. O. (2013). Is it Time to Abandon Stavudine? The Safety and Tolerability of Low Dose Stavudine versus Zidovudine in Urban Kenya. African Journal of Pharmacology and Therapeutics Vol, 2(2), 38-47.Publisher
College of Health sciences
Collections
- Faculty of Health Sciences (FHS) [10378]