Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.

<h4>Background</h4>To compare the incidence and timing of toxicity associated with the use of a reduced dose of stavudine from 40 to 30 mg in first-line antiretroviral therapy (ART) for HIV treatment and to investigate associated risk factors.<h4>Methods</h4>Multicohort study...

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Autores principales:	Mar Pujades-Rodríguez, Emmanuelle Dantony, Loretxu Pinoges, René Ecochard, Jean-François Etard, Esther Carrillo-Casas, Elisabeth Szumilin, AIDS Working Group of Médecins Sans Frontières
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/55981807dc624f34a168e91a1d0f1a79
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spelling	oai:doaj.org-article:55981807dc624f34a168e91a1d0f1a792021-11-18T07:33:50ZToxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.1932-620310.1371/journal.pone.0028112https://doaj.org/article/55981807dc624f34a168e91a1d0f1a792011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22132226/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>To compare the incidence and timing of toxicity associated with the use of a reduced dose of stavudine from 40 to 30 mg in first-line antiretroviral therapy (ART) for HIV treatment and to investigate associated risk factors.<h4>Methods</h4>Multicohort study including 23 HIV programs in resource-limited countries. Adults enrolled between January 2005 and December 2009. Four-year rates of all-cause and stavudine-specific toxicity were estimated. Multilevel mixed-effect Poisson and accelerated failure models were used to investigate factors associated with toxicity and timing of diagnosis.<h4>Findings</h4>A total of 48,785 patients contributed 62,505 person-years of follow-up. Rate of all-cause toxicity was 7.80 (95%CI 7.59-8.03) per 100 person-years, but varied greatly across sites (range 0.41-21.76). Patients treated with stavudine 40 mg had higher rates of toxicity (adjusted rate ratio [aRR] 1.18, 95%CI 1.06-1.30 during the first year of ART; and 1.51, 95%CI 1.32-1.71 during the second year). Women, older age, initial advanced clinical stage, and low CD4 count were associated with increased toxicity rate ratios. Timing of lipodystrophy and peripheral neuropathy diagnosis were 12% and 13% shorter, respectively, in patients treated with stavudine 40 mg than in those receiving 30 mg stavudine dose (P = 0.03 and 0.07, respectively). INSTERPRETATION: Higher rates of drug-related toxicity were reported in patients receiving stavudine 40 mg compared with 30 mg, and the time to toxicity diagnosis was shorter in patients treated with the higher dose. Higher rates of toxicity were observed during the first two years of ART.Mar Pujades-RodríguezEmmanuelle DantonyLoretxu PinogesRené EcochardJean-François EtardEsther Carrillo-CasasElisabeth SzumilinAIDS Working Group of Médecins Sans FrontièresPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 11, p e28112 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mar Pujades-Rodríguez Emmanuelle Dantony Loretxu Pinoges René Ecochard Jean-François Etard Esther Carrillo-Casas Elisabeth Szumilin AIDS Working Group of Médecins Sans Frontières Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
description	<h4>Background</h4>To compare the incidence and timing of toxicity associated with the use of a reduced dose of stavudine from 40 to 30 mg in first-line antiretroviral therapy (ART) for HIV treatment and to investigate associated risk factors.<h4>Methods</h4>Multicohort study including 23 HIV programs in resource-limited countries. Adults enrolled between January 2005 and December 2009. Four-year rates of all-cause and stavudine-specific toxicity were estimated. Multilevel mixed-effect Poisson and accelerated failure models were used to investigate factors associated with toxicity and timing of diagnosis.<h4>Findings</h4>A total of 48,785 patients contributed 62,505 person-years of follow-up. Rate of all-cause toxicity was 7.80 (95%CI 7.59-8.03) per 100 person-years, but varied greatly across sites (range 0.41-21.76). Patients treated with stavudine 40 mg had higher rates of toxicity (adjusted rate ratio [aRR] 1.18, 95%CI 1.06-1.30 during the first year of ART; and 1.51, 95%CI 1.32-1.71 during the second year). Women, older age, initial advanced clinical stage, and low CD4 count were associated with increased toxicity rate ratios. Timing of lipodystrophy and peripheral neuropathy diagnosis were 12% and 13% shorter, respectively, in patients treated with stavudine 40 mg than in those receiving 30 mg stavudine dose (P = 0.03 and 0.07, respectively). INSTERPRETATION: Higher rates of drug-related toxicity were reported in patients receiving stavudine 40 mg compared with 30 mg, and the time to toxicity diagnosis was shorter in patients treated with the higher dose. Higher rates of toxicity were observed during the first two years of ART.
format	article
author	Mar Pujades-Rodríguez Emmanuelle Dantony Loretxu Pinoges René Ecochard Jean-François Etard Esther Carrillo-Casas Elisabeth Szumilin AIDS Working Group of Médecins Sans Frontières
author_facet	Mar Pujades-Rodríguez Emmanuelle Dantony Loretxu Pinoges René Ecochard Jean-François Etard Esther Carrillo-Casas Elisabeth Szumilin AIDS Working Group of Médecins Sans Frontières
author_sort	Mar Pujades-Rodríguez
title	Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
title_short	Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
title_full	Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
title_fullStr	Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
title_full_unstemmed	Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
title_sort	toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/55981807dc624f34a168e91a1d0f1a79
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Toxicity associated with stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy.

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