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Changing utilization of Stavudine (d4T) in HIV‐positive people in 2006–2013 in the EuroSIDA study

2015; Wiley; Volume: 16; Issue: 9 Linguagem: Inglês

10.1111/hiv.12254

1468-1293

Daria Podlekareva, Daniel Grint, Igor Karpov, A. Vassilenko, Aza Rakmanova, K. Mansinho, N. Chentsova, E. Kravchenko, Indra Zeltiņa, M. Losso, Miłosz Parczewski, Jens Lundgren, Amanda Mocroft, Ole Kirk, M Kundro, Norman Vetter, Robert Zangerle, В. М. Мицура, O. Suetnov, Nathan Clumeck, S De Wit, M Delforge, Éric Florence, Linos Vandekerckhove, Vesna Hadžiosmanović, Kosta Kostov, J. Begovac, Ladislav Machala, David Jilich, Dalibor Sedláček, Jens Nielsen, Gitte Kronborg, Thomas Benfield, Michael Due Larsen, Jan Gerstoft, Terese L. Katzenstein, Ann‐Brit Eg Hansen, Peter Skinhøj, Court Pedersen, Lars Østergaard, Ulrik Bak Dragsted, L. N. Nielsen, Kersti Zilmer, Smidt Jelena Smidt, Matti Ristola, Christine Katlama, J.-P. Viard, Pierre Marie Girard, Philippe Vanhems, Christian Pradier, F. Dabis, D. Neau, Claudine Duvivier, JK Rockstroh, No Value Schmidt, Jan van Lunzen, Olaf Degen, H. J. Stellbrink, M. Bickel, J. W. Goethe, J. R. Bogner, G. Fätkenheuer, J. Kosmidis, Panagiotis Gargalianos, G. Xylomenos, J. Perdios, Helen Sambatakou, Dénes Bánhegyi, Magnús Gottfreðsson, F Mulcahy, Israel Yust, Dan Turner, Michael Burke, Simcha Pollack, Gamal Hassoun, Hila Elinav, M Haouzi, Antonella d’Arminio Monforte, Roberta Esposito, I. Mazeu, Cristina Mussini, Claudio Arici, R. Pristerà, F. Mazzotta, Andrea Gabbuti, Vincenzo Vullo, Miriam Lichtner, Antonio Chirianni, E. Montesarchio, Marcela Gargiulo, Gianpiero D’Offizi, Chiara Taibi, Andrea Antinori, Adriano Lazzarin, Antonella Castagna, Nicola Gianotti, Massimo Galli, Annalisa Ridolfo, Baiba Rozentāle, Saulius Chaplinskas, Thérèse Staub, R Hemmer, Peter Reiß, Vidar Ormaasen, A Mæland, Johan N. Bruun, Brygida Knysz, Jacek Gąsiorowski, Andrzéj Horban, Elżbieta Bąkowska, Anna Grzeszczuk, Robert Flisiak, Boron-Kaczmarska A. Boron-Kaczmarska, M. Pynka, Marek Beniowski, E. Mularska, H Trocha, Elżbieta Jabłonowska, Ewa Małolepsza, Kamila Wójcik, Manuela Doroana, L. Caldeira, Fernando Maltêz, Dan Duiculescu, Aza Rakhmanova, S. A. Buzunova, Irina Khromova, Elena Kuzovatova, Djordje Jevtović, M Mokrás, D Staneková, Janez Tomažič, J. González-Lahoz, Vincent Soriano, Pablo Labarga, Santiago Moreno, José Manuel Ramírez Rodríguez, Bonaventura Clotet, Antoni Jou, Roger Paredes, Cristina Tural, Jordi Puig, Isabel Bravo, JM Gatell, José M. Miró, Peré Domingo, María Luisa Navarro Gómez, Gràcia Mateo, Ma Antònia Sambeat, J. Medraño, Anders Blaxhult, Leo Flamholc, A. Thalme, Anders Sönnerborg, Bruno Ledergerber, Rainer Weber, P Francioli, Marie Paule Schneider, Bernard Hirschel, E. Boffi, H Furrer, Manuel Battegay, Luigia Elzi, Pietro Vernazza, В М Фролов, Galyna A Kutsyna, S. Servitskiy, Anastasiia Kuznetsova, Galyna Kyselyova, Brian Gazzard, Margaret Johnson, Erica Simons, Andrew Phillips, M. A. Johnson, Chloe Orkin, Jonathan Weber, G Scullard, Mark Fisher, Clifford Leen,

HIV/AIDS Research and Interventions

Objectives The long‐term side effects of stavudine (d4 T ) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe. Methods Patients taking combination antiretroviral therapy ( cART ) in EuroSIDA with follow‐up after 1 J anuary 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 . Results 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 N orthern E urope [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 E astern E urope ( 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. Conclusions d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in E astern E urope, 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.