Evaluation of efficacy of two drug regimens of anti-retro viral therapy
Keywords:CD4 Count, Efavirenz, Nevirapine, Tenofovir, Zidovudine
Background: CD4 count is an important marker to assess the effectiveness of treatment, mortality and survival rates in HIV patients on treatment. It is an important guide to treatment as it reflects drug resistance, treatment failure and need to switch over to different regimen. Objective of the study was to assess the efficacy of tenofovir (TDF) and efavirenz (EFV) versus zidovudine (AZT) and nevirapine (NVP), in combination with lamivudine (3TC) in HIV-infected patients taking basal and after treatment CD4 count levels as tools.
Methods: A retrospective observational study on 40 adult HIV patients, receiving AZT+3TC+NPV (ZLN) (group I) and 18 patients on TDF+3TC+EFV (TLE) (group II) was carried out. Demographic profile, medication prescribed, baseline CD4 cell counts, serially monitored CD4 count values and Hb% were recorded from patient's medical record. Student’s paired ‘t’ test was done to compare CD4 counts before and after treatment in individual groups. Unpaired ‘t’ test was used for the comparison of CD4 counts between the groups.
Results: A very highly significant (p<0.0001) increment in CD4 count was observed in group I after treatment. Improvement in CD4 count was highly significant in group II as well with p<0.0004. The extent of improvement was significantly better (p<0.05) in group I as compared to group II. Patients in group I were better staged clinically.
Conclusions: We conclude that ART regimen containing AZT/3TC/NVP is proved to be superior to TDF/3TC/EFV. However further studies need to be done, by taking drug adherence into account in a larger patient population.
National AIDS Control Organization.Ministry of Health and Family Welfare, Government of India, 2009. Available at https://nacoonline.org/NACO. Accessed on 16 November 2011.
d'Arminio Monforte A, Lepri AC, Rezza G, Pezzoti P, Antinori A, Phillips AN, et al. Insights into the reasons for discontinuation of the first highly active antretroviral therapy (HAART) regimen in a cohort of antiretroviral naοve patients: Italian cohort of antiretroviral Naοve patients. AIDS. 2000;14:499-507.
Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999;131:81-7.
Surmounting challenges: procurement of antiretroviral medicines in low- and middle-income countries. Available at http://apps.who.int/medicinedocs/en/d/Js4892e/
Stover J, Bollinger L, Avila C. Estimating the Impact and cost of the WHO 2010 recommendations for antiretroviral therapy. AIDS Research and Treatment,
;7:Article ID 738271.
Medhanie EK, Lukman M, Massi MN, Marianti A. Effectiveness of tenofovir (TDF)/emtricitabine (FTC) versus zidovudine (AZT)/lamivudine (3TC) in combination with efavirenz (EFV) in antiretroviral-naive HIV-infected patients in Eritrea. International Journal of Pharmaceutical and Clinical Research. 2015;7(5):364-7.
Sanchez-de la Rosa R, Herrera L, Moreno S. Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients. Clin Ther. 2008;30:372-81.
Bender MA, Kumarasamy N, Mayer KH, Wang B, Walensky RP, Flanigan T, et al. Cost-effectiveness of tenofovir as first-line antiretroviral therapy in India. Clin Infect Dis. 2010;50:416-25.
Rosen S, Long L, Fox M, Sanne I. Cost and cost-effectiveness of switching from stavudine to tenofovir in first-line antiretroviral regimens in South Africa. J Acquir Immune Defic Syndr. 2008;48(3):334-44.
Jouquet G, Bygrave H, Kranzer K, Ford N, Gadot L. Cost and cost effectiveness of switching from d4T or AZT to a TDF-based first-line regimen in a resource limited setting in rural Lesotho. J Acquir Immune Defic Syndr. 2011;58(3):e68-74.
Bendavid E, Grant P, Talbot A, Owens DK, Zolopa A. Cost-effectiveness of antiretroviral regimens in the World Health Organization’s treatment guidelines: a South African analysis. AIDS. 2011;25:211-20.
Brennan AT, Maskew M, Ive P, Shearer K, Long L, Sanne I, et al. Increases in regimen durability associated with the introduction of tenofovir at a large public-sector clinic in Johannesburg, South Africa. Journal of the International AIDS Society. 2013;16:18794.
Robert WS, Laua MS, Gregory KR, Victor DG, Sally WS, Richard TD, et al. AIDS clinical trials group 384 team comparison of sequential three-drug regimens as initial therapy for HIV-1 infection. N Engl J Med. 2003;349(24):2293-303.
Núñez M, Soriano V, Martín-Carbonero L, Barrios A, Barreiro P, Blanco F, et al. SENC (Spanish efavirenz versus nevirapine comparison) trial: a randomized, open-label study in HIV-infected naive individuals. HIV Clin Trials. 2002;3(3):186-94.
Van den Berg-Wolf M, Hullsiek KH, Peng G, Kozal MJ, Novak RM, Chen L, et al. CPCRA 058 study team, the terry beirn community programs for clinical research on AIDS (CPCRA), The International network for strategic initiative in global HIV Trials (INSIGHT). Virologic, immunologic, clinical, safety and resistance outcomes from a long-term comparison of efavirenz-based versus nevirapine-based antiretroviral regimens as initial therapy in HIV-1-infected persons. HIV Clin Trials. 2008;9(5):324-36.