Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi

 

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dc.contributor.author van Oosterhout, Joep J en_ZA
dc.contributor.author Mallewa, Jane en_ZA
dc.contributor.author Kaunda, Symon en_ZA
dc.contributor.author Chagoma, Newton en_ZA
dc.contributor.author Njalale, Yassin en_ZA
dc.contributor.author Kampira, Elizabeth en_ZA
dc.contributor.author Mukaka, Mavuto en_ZA
dc.contributor.author Heyderman, Robert S en_ZA
dc.date.accessioned 2015-11-23T12:34:40Z
dc.date.available 2015-11-23T12:34:40Z
dc.date.issued 2012 en_ZA
dc.identifier.citation van Oosterhout, J. J., Mallewa, J., Kaunda, S., Chagoma, N., Njalale, Y., Kampira, E., ... & Heyderman, R. S. (2012). Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi. PLoS One, 7(7), e42029. doi:10.1371/journal.pone.0042029 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15317
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0042029
dc.description.abstract BACKGROUND: Stavudine is an effective and inexpensive antiretroviral drug, but no longer recommended by WHO for first-line antiretroviral regimens in resource-limited settings due to toxicity concerns. Because of the high cost of alternative drugs, it has not been feasible to replace stavudine in most adults in the Malawi ART programme. We aimed to provide policy makers with a detailed picture of stavudine toxicities in Malawians on longer-term ART, in order to facilitate prioritization of stavudine replacement among other measures to improve the quality of ART programmes. METHODS: Prospective cohort of Malawian adults who had just completed one year of stavudine containing ART in an urban clinic, studying peripheral neuropathy, lipodystrophy, diabetes mellitus, high lactate syndromes, pancreatitis and dyslipidemia during 12 months follow up. Stavudine dosage was 30 mg irrespective of weight. Cox regression was used to determine associations with incident toxicities. RESULTS: 253 patients were enrolled, median age 36 years, 62.5% females. Prevalence rates (95%-confidence interval) of toxicities after one year on stavudine were: peripheral neuropathy 21.3% (16.5-26.9), lipodystrophy 14.7% (2.4-8.1), high lactate syndromes 0.0% (0-1.4), diabetes mellitus 0.8% (0-2.8), pancreatitis 0.0% (0-1.5). Incidence rates per 100 person-years (95%-confidence interval) during the second year on stavudine were: peripheral neuropathy 19.8 (14.3-26.6), lipodystrophy 11.4 (7.5-16.3), high lactate syndromes 2.1 (0.7-4.9), diabetes mellitus 0.4 (0.0-1.4), pancreatitis 0.0 (0.0-0.2). Prevalence of hypercholesterolemia and hypertriglyceridemia increased from 12.1% to 21.1% and from 29.5% to 37.6% respectively between 12 and 24 months. 5.5% stopped stavudine, 1.3% died and 4.0% defaulted during follow up. Higher age was an independent risk factor for incident peripheral neuropathy and lipodystrophy. CONCLUSION: Stavudine associated toxicities continued to accumulate during the second year of ART, especially peripheral neuropathy and lipodystrophy and more so at increasing age. Our findings support investments for replacing stavudine in first-line regimens in sub-Saharan Africa. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Toxicity en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Lipodystrophy en_ZA
dc.subject.other Peripheral neuropathy en_ZA
dc.subject.other Pancreatitis en_ZA
dc.subject.other Adults en_ZA
dc.subject.other Diabetes mellitus en_ZA
dc.subject.other Tuberculosis en_ZA
dc.title Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © van Oosterhout et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Human Genetics en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation van Oosterhout, J. J., Mallewa, J., Kaunda, S., Chagoma, N., Njalale, Y., Kampira, E., ... Heyderman, R. S. (2012). Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi. <i>PLoS One</i>, http://hdl.handle.net/11427/15317 en_ZA
dc.identifier.chicagocitation van Oosterhout, Joep J, Jane Mallewa, Symon Kaunda, Newton Chagoma, Yassin Njalale, Elizabeth Kampira, Mavuto Mukaka, and Robert S Heyderman "Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/15317 en_ZA
dc.identifier.vancouvercitation van Oosterhout JJ, Mallewa J, Kaunda S, Chagoma N, Njalale Y, Kampira E, et al. Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi. PLoS One. 2012; http://hdl.handle.net/11427/15317. en_ZA
dc.identifier.ris TY - Journal Article AU - van Oosterhout, Joep J AU - Mallewa, Jane AU - Kaunda, Symon AU - Chagoma, Newton AU - Njalale, Yassin AU - Kampira, Elizabeth AU - Mukaka, Mavuto AU - Heyderman, Robert S AB - BACKGROUND: Stavudine is an effective and inexpensive antiretroviral drug, but no longer recommended by WHO for first-line antiretroviral regimens in resource-limited settings due to toxicity concerns. Because of the high cost of alternative drugs, it has not been feasible to replace stavudine in most adults in the Malawi ART programme. We aimed to provide policy makers with a detailed picture of stavudine toxicities in Malawians on longer-term ART, in order to facilitate prioritization of stavudine replacement among other measures to improve the quality of ART programmes. METHODS: Prospective cohort of Malawian adults who had just completed one year of stavudine containing ART in an urban clinic, studying peripheral neuropathy, lipodystrophy, diabetes mellitus, high lactate syndromes, pancreatitis and dyslipidemia during 12 months follow up. Stavudine dosage was 30 mg irrespective of weight. Cox regression was used to determine associations with incident toxicities. RESULTS: 253 patients were enrolled, median age 36 years, 62.5% females. Prevalence rates (95%-confidence interval) of toxicities after one year on stavudine were: peripheral neuropathy 21.3% (16.5-26.9), lipodystrophy 14.7% (2.4-8.1), high lactate syndromes 0.0% (0-1.4), diabetes mellitus 0.8% (0-2.8), pancreatitis 0.0% (0-1.5). Incidence rates per 100 person-years (95%-confidence interval) during the second year on stavudine were: peripheral neuropathy 19.8 (14.3-26.6), lipodystrophy 11.4 (7.5-16.3), high lactate syndromes 2.1 (0.7-4.9), diabetes mellitus 0.4 (0.0-1.4), pancreatitis 0.0 (0.0-0.2). Prevalence of hypercholesterolemia and hypertriglyceridemia increased from 12.1% to 21.1% and from 29.5% to 37.6% respectively between 12 and 24 months. 5.5% stopped stavudine, 1.3% died and 4.0% defaulted during follow up. Higher age was an independent risk factor for incident peripheral neuropathy and lipodystrophy. CONCLUSION: Stavudine associated toxicities continued to accumulate during the second year of ART, especially peripheral neuropathy and lipodystrophy and more so at increasing age. Our findings support investments for replacing stavudine in first-line regimens in sub-Saharan Africa. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0042029 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi TI - Stavudine toxicity in adult longer-term ART patients in Blantyre, Malawi UR - http://hdl.handle.net/11427/15317 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.