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Home >> Publications >> Zidovudine impairs immunological recovery on first-line antiretroviral therapy: collaborative analysis of cohort studies in southern Africa.

Publication

Author(s):

Wandeler G, Gsponer T, Mulenga L, Garone D, Wood R, Maskew M, Prozesky H, Hoffmann C, Ehmer J, Dickinson D, Davies MA, Egger M, Keiser O; IeDEA Southern Africa Collaboration.

Pub Title:

Zidovudine impairs immunological recovery on first-line antiretroviral therapy: collaborative analysis of cohort studies in southern Africa.

Pub Date:

Sep 10 2013

Pub Region(s):

Southern Africa

Journal Issue:

27(14)

Page Number:
2225-32

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.10.0b/ovidweb.cgi?QS2=434f4e1a73d37e8c8b3eab7e2fc8fd7c3c8eb6b4092c40066cf1ad4dc698ab18043e87b8c892d05234a12cf31f5af07cf37096e556704cd2aea44f5874ee71a99861ef1174c3e4e4f99ca3ad44143f69d0787372db9e17678827dc730a77b53a78e8f19ac2

PubMed: 23660577
Pub PDF: PDF icon 23660577.pdf

Abstract
OBJECTIVES
: Zidovudine (ZDV) is recommended for first-line antiretroviral therapy (ART) in resource-limited settings. ZDV may, however, lead to anemia and impaired immunological response. We compared CD4+ cell counts over 5 years between patients starting ART with and without ZDV in southern Africa.

DESIGN: Cohort study.

METHODS: Patients aged at least 16 years who started first-line ART in South Africa, Botswana, Zambia, or Lesotho were included. We used linear mixed-effect models to compare CD4+ cell count trajectories between patients on ZDV-containing regimens and patients on other regimens, censoring follow-up at first treatment change. Impaired immunological recovery, defined as a CD4+ cell count below 100 cells/μl at 1 year, was assessed in logistic regression. Analyses were adjusted for baseline CD4+ cell count and hemoglobin level, age, sex, type of regimen, viral load monitoring, and calendar year.

RESULTS: A total of 72,597 patients starting ART, including 19,758 (27.2%) on ZDV, were analyzed. Patients on ZDV had higher CD4+ cell counts (150 vs.128 cells/μl) and hemoglobin level (12.0 vs. 11.0 g/dl) at baseline, and were less likely to be women than those on other regimens. Adjusted differences in CD4+ cell counts between regimens containing and not containing ZDV were -16 cells/μl [95% confidence interval (CI) -18 to -14] at 1 year and -56 cells/μl (95% CI -59 to -52) at 5 years. Impaired immunological recovery was more likely with ZDV compared to other regimens (odds ratio 1.40, 95% CI 1.22-1.61).

CONCLUSION: In southern Africa, ZDV is associated with inferior immunological recovery compared to other backbones. Replacing ZDV with another nucleoside reverse transcriptase inhibitor could avoid unnecessary switches to second-line ART.

PMID: 23660577 [PubMed - in process]

PMCID: PMC3815688 [Available on 2014/9/10]

 

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Citation:

Wandeler G, Gsponer T, Mulenga L, Garone D, Wood R, Maskew M, Prozesky H, Hoffmann C, Ehmer J, Dickinson D, Davies MA, Egger M, Keiser O; IeDEA Southern Africa Collaboration. Zidovudine impairs immunological recovery on first-line antiretroviral therapy: collaborative analysis of cohort studies in southern Africa. AIDS. 2013 Sep 10;27(14):2225-32. doi: 10.1097/QAD.0b013e328362d887. PubMed PMID: 23660577; PubMed Central PMCID: PMC3815688.