aDivision of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern bDepartment of Infectious Diseases, University Hospital Bern, Bern, Switzerland cCentre for Infectious Disease Research in Zambia, Lusaka, Zambia dKhayelitsha ART Programme, Médecins Sans Frontières, Cape Town eThe Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town fThemba Lethu Clinic, Johannesburg gDivision of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town hAurum Institute for Health Research, Johannesburg, South Africa iSolidarMed Lesotho, Lucerne, Switzerland jHIV private practice, Gaborone, Botswana kSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
AIDS. 2013 Sep 10;27(14):2225-32. doi: 10.1097/QAD.0b013e328362d887.
Zidovudine (ZDV) is recommended for first-line antiretroviral therapy (ART) in resource-limited settings. ZDV may, however, lead to anemia and impaired immunological response. We compared CD4+ cell counts over 5 years between patients starting ART with and without ZDV in southern Africa.
Cohort study.
Patients aged at least 16 years who started first-line ART in South Africa, Botswana, Zambia, or Lesotho were included. We used linear mixed-effect models to compare CD4+ cell count trajectories between patients on ZDV-containing regimens and patients on other regimens, censoring follow-up at first treatment change. Impaired immunological recovery, defined as a CD4+ cell count below 100 cells/μl at 1 year, was assessed in logistic regression. Analyses were adjusted for baseline CD4+ cell count and hemoglobin level, age, sex, type of regimen, viral load monitoring, and calendar year.
A total of 72,597 patients starting ART, including 19,758 (27.2%) on ZDV, were analyzed. Patients on ZDV had higher CD4+ cell counts (150 vs.128 cells/μl) and hemoglobin level (12.0 vs. 11.0 g/dl) at baseline, and were less likely to be women than those on other regimens. Adjusted differences in CD4+ cell counts between regimens containing and not containing ZDV were -16 cells/μl [95% confidence interval (CI) -18 to -14] at 1 year and -56 cells/μl (95% CI -59 to -52) at 5 years. Impaired immunological recovery was more likely with ZDV compared to other regimens (odds ratio 1.40, 95% CI 1.22-1.61).
In southern Africa, ZDV is associated with inferior immunological recovery compared to other backbones. Replacing ZDV with another nucleoside reverse transcriptase inhibitor could avoid unnecessary switches to second-line ART.
齐多夫定（ZDV）被推荐用于资源有限的环境中的一线抗逆转录病毒治疗（ART）。然而，ZDV 可能导致贫血和免疫应答受损。我们比较了在南部非洲开始使用 ART 且包含 ZDV 和不包含 ZDV 的患者在 5 年内的 CD4+细胞计数。
队列研究。
纳入年龄至少 16 岁且在南非、博茨瓦纳、赞比亚或莱索托开始一线 ART 的患者。我们使用线性混合效应模型比较了包含 ZDV 的方案和其他方案的患者的 CD4+细胞计数轨迹，并在首次治疗改变时对随访进行了删失。使用逻辑回归评估免疫恢复受损的情况，定义为 1 年内 CD4+细胞计数低于 100 个/μl。分析调整了基线 CD4+细胞计数和血红蛋白水平、年龄、性别、方案类型、病毒载量监测和日历年份。
共分析了 72597 名开始 ART 的患者，其中 19758 名（27.2%）使用 ZDV。与其他方案相比，使用 ZDV 的患者基线时的 CD4+细胞计数（150 比 128 个/μl）和血红蛋白水平（12.0 比 11.0 g/dl）更高，且女性比例低于其他方案。在包含 ZDV 和不包含 ZDV 的方案之间，调整后的 CD4+细胞计数差异在 1 年时为-16 个/μl（95%置信区间 [CI] -18 至-14），在 5 年时为-56 个/μl（95% CI -59 至-52）。与其他方案相比，使用 ZDV 更有可能导致免疫恢复受损（比值比 1.40，95% CI 1.22-1.61）。
在南部非洲，与其他骨干药物相比，ZDV 与免疫恢复不良相关。用另一种核苷逆转录酶抑制剂替代 ZDV 可能避免不必要地转换为二线 ART。
