Laurent Christian auteur aut IRD Bourgeois Anke auteur aut IRD Mpoudi Ngolé E. auteur aut IRD Ciaffi L. auteur aut IRD Kouanfack C. auteur aut IRD Mougnutou R. auteur aut IRD Nkoué N. auteur aut IRD Calmy A. auteur aut IRD Koulla-Shiro S. auteur aut IRD Delaporte Eric auteur aut IRD text journalArticle eng text/pdf born digital access 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. specialized 052 050 24 3 393-399 2008 0889-2229 https://www.documentation.ird.fr/hor/fdi:010042508 10.1089/aid.2007.0219 0889-2229 [F B010042508] https://www.documentation.ird.fr/hor/fdi:010042508 https://www.documentation.ird.fr/intranet/publi/2008/04/010042508.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2008-05-06 2017-08-23 fdi:010042508 fre