This is good news. For all the complaining about the standard first line triple combination antiretroviral therapy stavudine lamivudine nevirapine, it appears to be remarkably effective.
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HIV Medicine
Volume 8 Issue 1 Page null - January 2007
To cite this article: J Zhou, NI Paton, R Ditangco, Y-MA Chen, A Kamarulzaman, N Kumarasamy, CKC Lee, PCK Li, TP Merati, P Phanuphak, S Pujari, A Vibhagool, F Zhang, J Chuah, KR Frost, DA Cooper, MG Law, on behalf of the TREAT Asia HIV Observational Database (2007)
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), --.
doi:10.1111/j.1468-1293.2007.00417.x
ORIGINAL RESEARCH
Experience with the use of a first-line regimen of stavudine, lamivudine and nevirapine in patients in the TREAT Asia HIV Observational Database
* J Zhou11National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia, ,
* NI Paton22Tan Tock Seng Hospital, Singapore, ,
* R Ditangco33Research Institute for Tropical Medicine, Manila, Philippines, ,
* Y-MA Chen44AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan, ,
* A Kamarulzaman55University of Malaya, Kuala Lumpur, Malaysia, ,
* N Kumarasamy66YRG Centre for AIDS Research and Education, Chennai, India, ,
* CKC Lee77Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, ,
* PCK Li88Queen Elizabeth Hospital, Hong Kong, China, ,
* TP Merati99School of Medicine, Udayana University & Sanglah Hospital, Denpasar, Bali, Indonesia, ,
* P Phanuphak1010HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, ,
* S Pujari1111HIV Project, Ruby Hall Clinic, Pune, India, ,
* A Vibhagool1212Ramathibodi Hospital, Bangkok, Thailand, ,
* F Zhang1313Beijing Ditan Hospital, Beijing, China, ,
* J Chuah1414Gold Coast Sexual Health Clinic, Miami, Qld, Australia, ,
* KR Frost1515American Foundation for AIDS Research, New York, NY, USA,
* DA Cooper11National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia, and
* MG Law11National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia,
* on behalf of the TREAT Asia HIV Observational Database
*
1National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia, 2Tan Tock Seng Hospital, Singapore, 3Research Institute for Tropical Medicine, Manila, Philippines, 4AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan, 5University of Malaya, Kuala Lumpur, Malaysia, 6YRG Centre for AIDS Research and Education, Chennai, India, 7Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, 8Queen Elizabeth Hospital, Hong Kong, China, 9School of Medicine, Udayana University & Sanglah Hospital, Denpasar, Bali, Indonesia, 10HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 11HIV Project, Ruby Hall Clinic, Pune, India, 12Ramathibodi Hospital, Bangkok, Thailand, 13Beijing Ditan Hospital, Beijing, China, 14Gold Coast Sexual Health Clinic, Miami, Qld, Australia, 15American Foundation for AIDS Research, New York, NY, USA
Correspondence: Mr Jialun Zhou, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia. Tel: + 612 93850900; fax: +612 93850920; e-mail: jzhou@nchecr.unsw.edu.au
Background
The antiretroviral treatment (ART) combination of stavudine, lamivudine and nevirapine (d4T/3TC/NVP) is the most frequently used initial regimen in many Asian countries. There are few data on the outcome of this treatment in clinic cohorts in this region.
Methods
We selected 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 haemoglobin (i.e. anaemia) 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.
Conclusion
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.
