%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Laurent, Christian
%A Bourgeois, Anke
%A Mpoudi Ngolé, E.
%A Ciaffi, L.
%A Kouanfack, C.
%A Mougnutou, R.
%A Nkoué, N.
%A Calmy, A.
%A Koulla-Shiro, S.
%A Delaporte, Eric
%T Tolerability and effectiveness of first-line regimens combining Nevirapine and lamivudine plus zidovudine or Stavudine in Cameroon
%D 2008
%L fdi:010042508
%G ENG
%J Aids Research and Human Retroviruses
%@ 0889-2229
%M CC:0002547352-0008
%N 3
%P 393-399
%R 10.1089/aid.2007.0219
%U https://www.documentation.ird.fr/hor/fdi:010042508
%> https://www.documentation.ird.fr/intranet/publi/2008/04/010042508.pdf
%V 24
%W Horizon (IRD)
%X We compared the tolerability and effectiveness of two major first-line regimens used in resource-limited settings, namely zidovudine-lamivudine-nevirapine and stavudine-lamivudine-nevirapine. HIV-1-infected adults in Cameroon were enrolled in a prospective cohort study between 2001 and 2003. They were eligible if they had AIDS or a CD4 cell count below 350/mm(3), a Karnofsky score over 50%, and no contraindications to antiretroviral treatment. The patients were followed up to 2 years. Of 169 patients, 85 received zidovudine-lamivudine-nevirapine and 84 stavudine-lamivudine-nevirapine. The incidence rates of treatment changes, death, drug resistance, and severe adverse effects were, respectively, 12.0 [ 95% confidence interval (CI) 7.2-19.9] and 10.9 ( CI 6.4-18.3) per 100 person-years; 5.7 ( CI 2.8-11.4) and 7.6 ( CI 4.2-13.7); 2.9 ( CI 1.1-7.7) and 5.0 ( CI 2.4-10.6); and 41.7 ( CI 30.2-57.6) and 49.1 ( CI 36.1-66.6). The Kaplan-Meier curves for the likelihood of remaining on the initial regimen ( p = 0.8) and for survival ( p = 0.5) did not differ significantly between the groups. In Cox multivariate analysis only a lower baseline CD4 cell count was associated with death ( p < 0.001). The proportion of patients with undetectable viral load and the increase in the CD4 cell count were similar in the two groups. Anemia was rare ( 4% vs. 6%). Five cases of severe peripheral neuropathy and one case of lipodystrophy occurred. This study suggests that the zidovudine-lamivudine-nevirapine combination is a safe first-line treatment, even in settings with few laboratory resources. In view of stavudine toxicity, these results support recommendations calling for a gradual switch from stavudine- to zidovudine-based regimens.
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