Is zidovudine first-line therapy virologically comparable to tenofovir in resource-limited settings?
OBJECTIVE
To compare virologic success between adult patients on tenofovir (TDF) and zidovudine (AZT)-containing first-line antiretroviral (ART) regimens in 10 rural clinics in Lesotho, Southern Africa.


METHODS
Multicentre cross-sectional study, patients ≥16 years, on first-line ART ≥6 months, receiving AZT/lamivudine (3TC) or TDF/3TC combined with efavirenz (EFV) or nevirapine (NVP). Patient characteristics and clinical/therapeutic history were collected on the day of blood draw for viral load (VL). Analysis was stratified for non-nucleoside reverse transcriptase inhibitor (EFV or NVP). A logistic regression model weighted for patients' baseline characteristics was used to assess the likelihood of virologic success (<80 copies/ml) in patients with TDF- as compared to AZT-backbones.


RESULTS
In total 1539 patients were included in the analysis. Most were clinically and immunologically stable (clinical failure: 2.7% (AZT) and 2.8% (TDF); immunological failure: 4.6% (AZT) and 4.8% (TDF)). In EFV-based regimens (n = 1162), TDF was significantly associated with higher rates of virologic suppression than AZT (93.8% vs. 88.1%; weighted odds ratio: 2.15 (95% CI: 1.29-3.58; P = 0.003)). In NVP-based regimens, a similar trend was observed, but not significant (89.4% vs. 86.7%; 1.99 (0.83-4.75, P = 0.121)).


CONCLUSION
These findings support the WHO recommendation to use TDF/3TC/EFV as first-line regimen. They do, however, not support the recommendation that patients who are clinically stable on AZT should continue on this first-line regimen.
['Labhardt|Niklaus D|ND|', 'Bader|Joëlle|J|', 'Lejone|Thabo Ismael|TI|', 'Ringera|Isaac|I|', 'Puga|Daniel|D|', 'Glass|Tracy R|TR|', 'Klimkait|Thomas|T|']
D000225:Adenine D000328:Adult D000480:Alkynes D019380:Anti-HIV Agents D023241:Antiretroviral Therapy, Highly Active D048588:Benzoxazines D003430:Cross-Sectional Studies D003521:Cyclopropanes D005260:Female D006678:HIV D015658:HIV Infections D006295:Health Resources D006801:Humans D019259:Lamivudine D007927:Lesotho D016015:Logistic Models D008297:Male D008875:Middle Aged D063065:Organophosphonates D000068698:Tenofovir D019562:Viral Load D015215:Zidovudine
zidovudine Tenofovir Tenofovir Africa viral load Carga Viral HIV Inhibidor Nucleósido de la Transcriptasa Inversa Terapia Antirretroviral VIH Zidovudina anti-retroviral therapy charge virale inhibiteur de la transcriptase inverse nucléosidique l'Afrique nucleoside reverse transcriptase inhibitor tenofovir thérapie antirétrovirale ténofovir África