Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India
Keywords:Anti-retroviral drugs, CD4% count HIV, TLE, ZLN
Background: HAART (Highly active antiretroviral therapy) is the cornerstone of management of patients with HIV infection. Antiretroviral therapy was started in the year 1986 with the first drug Zidovudine (ZDV). Later on, other antiretroviral drugs (NRTIs, NNRTIs and Pls) were introduced. Dual and mono therapies were used initially but the problem of resistance emerged. Currently, 3 or more ARV drugs are recommended globally for the treatment of people with HIV infection.
Methods: A cross-sectional descriptive study conducted at a tertiary care Hospital over 200 patients, two commonly used medications are ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz ). The factors considered to affect the clinical and immunologic outcomes in both groups were assessed using baseline CD4 count, WHO clinical staging, presence of chronic diarrhea, anemia, and baseline weight, occurrence of TB, and switching of ART regimen.
Results: A total of 200 patients were included in the study. ART documents of 100 patients are on Zidovudine+Lamivudine+Nevirapine) and 100 patients are on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. Out of 200 patients, 97 were males and 103 were females. Maximum number of subjects were in the age of 15-45 years (82.5%) followed by 45 and above (17.5%). Mean age was 34.5±2.5 (years) with range 15 to 65 years. The baseline CD4 count of the patients, 94 were <350 and 6 were ≥350 on ZLN, in case of TLE 82 were <350 and 18 were ≥350. CD4 count after 6 months in 200 patients as follows, 60 were <350 and 40 were ≥350 in case of TLE 53 were <350 and 47 were ≥350.
Conclusions: This research finding concluded that there is no critical difference between the two medications in regards to serious adverse events but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance.
Gulick RM, Ribaudo HJ, Shikuma CM, Lustgarten S, Squires KE, Meyer III WA, et al. Triple-nucleoside regimens versus efavirenz-containing regimens for the initial treatment of HIV-1 infection. New England J Med. 2004 Apr 29;350(18):1850-61.
Kwofie TB, Owusu M, Mutocheluh M, Nguah SB, Obeng-Baah J, Hanson C, et al. Pattern and predictors of immunologic recovery in HIV infected patients. BMC Res Notes. 2015 Dec;8(1):413.
Velen K, Lewis JJ, Charalambous S, Grant AD, Churchyard GJ, Hoffmann CJ. Comparison of tenofovir, zidovudine, or stavudine as part of first-line antiretroviral therapy in a resource-limited-setting: a cohort study. PloS one. 2013 May 14;8(5):e64459.
Dadi TL, Kefale AT, Mega TA, Kedir MS, Addo HA, Biru TT. Efficacy and tolerability of tenofovir disoproxil fumarate based regimen as compared to zidovudine based regimens: a systematic review and meta-analysis. AIDS Res Treat. 2017;2017:5792925.
Ayele T, Jarso H, Mamo G. Clinical outcomes of tenofovir versus zidovudine-based regimens among people living with HIV/AIDS: a two years retrospective cohort study. Open AIDS J. 2017;11:1-11.
Awino M. (2008). Prevalence and Management of Opportunistic Infections in HIV-Infected Children. Available at: http://erepository.uonbi.ac.ke/.
Wandeler G, Gerber F, Rohr J, Chi BH, Orrell C, Chimbetete C, et al. Tenofovir or zidovudine in second-line antiretroviral therapy after stavudine failure in southern Africa. Antivir Ther. 2014;19(5):521.
Insaniputri P, Supardi S, Andrajati, R. Comparison of zidovudine combination and tenofovir combination on the effectiveness of therapy and side effects in HIV/AIDS patients in rsal mintohardjo. Asian J Pharm Clin. Res. 2017;10(Supp 5):93-6.
Saez-Llorens X, Castaño E, Rathore M, Church J, Deville J, Gaur A, et al. A randomized, open-label study of the safety and efficacy of switching stavudine or zidovudine to tenofovir disoproxil fumarate in HIV-1-infected children with virologic suppression. Pediatr Infect Dis J. 2015 Apr 1;34(4):376-82.
National Aids Control Organisation. ART Guidelines for HIV-Infected Adults and Adolescents Including Post-Exposure Prophylaxis. New Delhi: NACO, 2013. Available at: http:// www.naco.gov.in/upload/Policies%20&%20Guidelines/Antiretroviral%20Therapy%20Guidelines%20for%20HIVInfected%20Adults%20and%20Adolescents.
Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002 Jul 13;360(9327):119-29.
Mellors JW, Munoz A, Giorgi JV, Margolick JB, Tassoni CJ, Gupta P, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Annals Inter Med. 1997 Jun 15;126(12):946-54.
Moore RD, Chaisson RE. Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS. 1999 Oct 1;13(14):1933-42.
Hemasri M, Sudhapoornima P, Sowmya Sri CH, Ramya S, Avinash I, Kiran Kumar B. Safety and effectiveness of anti-retroviral drug regimens ZLN and TLE in tertiary care teaching hospital: a prospective observational study. IOSR. 2016;11(2):88-96.
Sorsa A. Clinical, immunological and virological responses of zidovudine-lamivudine-nevirapine versus zidovudine-lamivudine-efavirenz antiretroviral treatment (ART) among HIV-1 infected children: Asella teaching and referral hospital, South-East Ethiopia. Open Med Inform J. 2018;12:11-8.