title: Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia.
abstract: OBJECTIVE
  To evaluate a treatment strategy of substituting zidovudine (ZDV) for stavudine (d4T)-based highly active antiretroviral therapy (HAART), aimed at preventing d4T-associated toxicity, in a programmatic setting in rural Cambodia.
  
  
  METHODS
  Survival probability, CD4 gain, anemia incidence, and factors associated with severe anemia were analyzed in a cohort of adult patients switched from d4T- to ZDV-containing regimens from March 2006 to March 2007.
  
  
  RESULTS
  Among 527 patients systematically switched to ZDV after d4T-based HAART for a median of 18 months, 4 (0.8%) patients died, 2 (0.4%) were lost to follow-up, 18 (3.4%) were transferred out, and 503 (95.4%) remained on HAART. Median CD4 gain was +263.5 cells/microL (interquartile range: 89.25-369.5) at 24 months. Within 1 year after the switch, 21.9% and 7.1% of patients developed anemia (grades 1-4) and severe anemia (grades 3-4), respectively. Low body mass index (< or =18) and low CD4 count (<200 cells/microL) at the time of switch were factors associated with severe anemia. Additional follow-up visits for laboratory monitoring and adherence counseling, increased absenteeism from work, and transportation costs for the patients were noted.
  
  
  CONCLUSIONS
  The switch strategy of substituting ZDV for d4T-based HAART led to satisfactory overall clinical outcomes. However, it resulted in a relatively high incidence of mild to severe anemia and increased burden for the program and the patients.
authors.affiliation: Médecins Sans Frontières OCB, Phnom Penh, Cambodia. msfb-phnom-penh-med@brussels.msf.org
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Raguenaud
authors.forename: Thong
authors.initials: T
authors.lastname: Phe
authors.forename: Sam A
authors.initials: SA
authors.lastname: Khim
authors.forename: Sokhan
authors.initials: S
authors.lastname: Kuoch
authors.forename: Sopheap
authors.initials: S
authors.lastname: Khem
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
authors.forename: Line
authors.initials: L
authors.lastname: Arnould
mesh_terms: D000740:Anemia / Q000139:chemically induced; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002160:Cambodia; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D018119:Stavudine / Q000008:administration & dosage; D015215:Zidovudine / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D015215:Zidovudine; D018119:Stavudine