Podlekareva D, Grint D, Karpov I, Rakmanova A, Mansinho K, Chentsova N, Zeltina I, Losso M, Parczewski M, Lundgren J D, Mocroft A, Kirk O
CHIP, Department of Infectious Diseases Rigshospitalet, University of Copenhagen, Denmark.
UCL - Royal Free Campus, London, UK.
HIV Med. 2015 Oct;16(9):533-43. doi: 10.1111/hiv.12254. Epub 2015 May 18.
The long-term side effects of stavudine (d4T) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe.
Patients taking combination antiretroviral therapy (cART) in EuroSIDA with follow-up after 1 January 2006 were included in the study. cART was defined as d4T-containing [d4T plus at least two other antiretrovirals (ARVs) from any class] or non-d4T-containing (at least three ARVs from any class, excluding d4T). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T.
A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval (CI) 19-20%]. d4T use declined fastest in Northern Europe [26% (95% CI 23-29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16-19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio (aIRR) 0.86; 95% CI 0.80-0.91]. Factors associated with initiating d4T were residence in Eastern Europe (aIRR 4.31; 95% CI 2.17-9.98) versus other European regions and HIV RNA > 400 copies/mL (aIRR 3.11; 95% CI 1.60-6.02) versus HIV RNA < 400 copies/mL.
d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in Eastern Europe, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV-positive patients are aware of the potential harmful effects associated with d4T.
司他夫定（d4T）的长期副作用致使2009年提出逐步淘汰该药物使用的建议。我们旨在描述欧洲范围内d4T的使用时间模式。
纳入在欧洲艾滋病临床研究数据库（EuroSIDA）中于2006年1月1日后接受随访的接受联合抗逆转录病毒治疗（cART）的患者。cART被定义为含d4T方案（d4T加至少两种来自任何类别的其他抗逆转录病毒药物[ARV]）或不含d4T方案（至少三种来自任何类别的ARV，不包括d4T）。采用泊松回归来描述d4T使用患病率的时间变化以及与开始使用d4T相关的因素。
共有5850名在2006年1月1日接受cART的患者纳入当前分析，到2013年1月1日增至7768名患者。在此期间，d4T的使用率从11.2%降至0.7%，每6个月总体下降19%[95%置信区间（CI）19 - 20%]。d4T在北欧的使用下降最快[每6个月26%（95%CI 23 - 29%）]，在东欧最慢[每6个月17%（95%CI 16 - 19%）]。在多变量泊松回归模型中，新开始使用d4T的情况每6个月减少14%[调整发病率比（aIRR）0.86；95%CI 0.80 - 0.91]。与开始使用d4T相关的因素包括居住在东欧（与其他欧洲地区相比，aIRR 4.31；95%CI 2.17 - 9.98）以及HIV RNA＞400拷贝/mL（与HIV RNA＜400拷贝/mL相比，aIRR 3.11；95%CI 1.60 - 6.02）。
自2006年以来，d4T的使用已大幅下降，在大多数地区降至低水平；然而，东欧仍存在低但持续的d4T使用情况，2006年后新开始使用d4T的情况也更为常见。地区差异的原因可能是多因素的，但确保所有治疗HIV阳性患者的临床医生了解与d4T相关的潜在有害影响非常重要。
