Comparison of Outcomes of Tenofovir and Zidovudine Based First-Line Antiretroviral Therapy Regimens at Zewditu Memorial Hospital: Retrospective Cohort Study
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Date
2018-04
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Addis Ababa Universty
Abstract
Comparison of Outcomes of Tenofovir and Zidovudine Based First-Line Antiretroviral
Therapy Regimens at Zewditu Memorial Hospital: Retrospective Cohort Study
Abel Terrefe
Addis Ababa University, 2018
Human immunodeficiency virus (HIV) is one of the major health problems in the world. Nearly
37 million people are living with the disease. Antiretroviral therapy (ART) significantly reduces
mortality and morbidity of HIV patients. Despite the successes of ART, high incidence of
frequent change of initial therapy has been consistently observed. Tenofovir (TDF) is a first-line
antiretroviral (ARV) agent recently introduced in resource limited areas. It is well tolerated and
effective in studies from developed countries. However there is limited information on the
effectiveness and tolerability outcomes of TDF based regimens in Ethiopia. The aim of this study
was to compare the outcomes of TDF and zidovudine (AZT) based regimens focusing on toxicity
driven regimen substitution, mortality and lost to follow up. Retrospective cohort study was
conducted at Zewditu Memorial Hospital (ZMH). A total of 223 ART naïve patients who started
ART between August 31, 2010 and August 31, 2013 were included. Data was collected by
review of patients’ medication record. Data was analyzed using statistical package for social
sciences (SPSS) 20.0. Kaplan-Meier was used to compare survival experience in TDF and AZT
groups and Cox regression was used to identify independent predictors of toxicity driven
regimen substitution and mortality. The mean standard deviation (SD) age of participants was
37.07 (10.17) years for TDF and 35.27 (7.52) years for AZT groups. Majority of female patients
(57.9%) were in TDF group. The risk of toxicity driven regimen substitution was 5 times higher
in AZT than TDF group (adjusted hazard ratio (AHR=5.07, 95% CI (1.4-18.33), P=0.013). There
was no statistically significant difference in mortality and program failure between TDF and
AZT groups. According to this study TDF has superior safety and similar effectiveness as
compared to AZT for the treatment of HIV. The finding of this study supports the recent
implementation of TDF as a first-line ARV in resourced limited settings.
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Keywords
ART, TDF, AZT, Toxicity driven regimen substitution, Mortality, Zewditu Memorial Hospital