Prevalence of anemia from a systematic substitution of Zidovudine for Stavudine-based HAART in a program setting in Phan Hospital, Chiangrai

Abstract

Background : National guidelines on HIV/AIDS diagnosis and treatment:Thailand
2006/2007 recommened to use two NRTI plus one NNRTI for initial firstline
standard HAART regimen, mostly GPO-VIR S (d4T + 3TC + NVP) was
prefered because easy to use, low short-term toxicity, high efficacy, has
generic drug, low-cost and fixed-dose combinations that enhances patient
adherence. There was increasing evidence that d4T associated with longterm
side effect especially on lipoatrophy / lipodystrophy or peripheral
neuropathy and then zidovudine (AZT) was widely substituted. Afterthat,
there was increasing in the incidence of anemia from AZT.
Objective : To evaluate prevalence of anemia and identify risk factor that associated
with anemia from a systematic substitution of Zidovudine for Stavudinebased
HAART in a program setting in Phan Hospital, Chiangrai.
Methods : This was a retrospective, observational study using data routinely collected
at each follow-up during January 2006 to September 2010. The data were
recorded at time of switch from d4T to AZT-based HAART.

Results : Among 185 patients systematically switched to AZT-based regimen within
1 year after the switch, 29 patients (15.7 percent) developed anemia, mostly
mild anemia (grade 1) 19 patients (10.3 percent), inferior to critical anemia
(grade 4) 8 patients (4.3 percent), and moderate anemia (grade 2) 2 patients
(1.1 percent). The median time after switching to AZT-based regimen until
developing anemia. was 20 weeks ( Interquartile Range: IQR = 12.0 - 28.0
weeks). The data analysis found that female sex had statistically significant
risk factor to developing anemia in this study (p < 0.05)
Conclusion : The prevalence of anemia from a systematic substitution of Zidovudine for
Stavudine-based HAART in a program setting in Phan Hospital, Chiangrai
was 15.7 percent and the data analysis found that female sex had statistically
significant risk factor to developing anemia in this study (p < 0.05).
Keywords : Zidovudine, Stavudine, anemia, highly active antiretroviral treatment
(HAART)