Switch from zidovudine- to non-zidovudine-containing regimens is associated with modest haematological improvement and no obvious clinical benefit: a substudy of the ANRS 099 ALIZE trial.
BACKGROUND
Zidovudine, the first antiretroviral agent, has short-term haematological toxicity. However, it is unclear whether patients tolerating long-term zidovudine-containing regimens will benefit from a switch to non-zidovudine-containing regimens.


METHODS
One hundred and fifty-eight patients enrolled in the ALIZE trial receiving zidovudine at baseline were analysed. These patients were randomized to continue their regimen or to switch to a combination of emtricitabine, didanosine and efavirenz for 48 weeks. Changes from baseline in haemoglobin (Hb), neutrophil and platelet counts were compared between arms as well as the occurrence of cardiovascular events, bacterial infections, use of haematopoietic growth factors, blood transfusion and quality of life using the Medical Outcome Study HIV (MOS-HIV) health survey.


RESULTS
Eighty-one patients continued their regimen and 77 switched. At 48 weeks, mean change from baseline in Hb were +0.73 and -0.37 g/dL in the switch and maintenance groups, respectively (P < 0.01). Mean neutrophil counts increased by 592 and 51 cells/mm(3) in the switch and maintenance groups, respectively (P = 0.02). The occurrence of cardiovascular events or bacterial infections was similar in both treatment arms with no use of haematopoietic growth factors or blood transfusion. Also, mean change from baseline in MOS-HIV physical and mental health summary scores was similar in both arms.


CONCLUSIONS
A switch from a long-standing zidovudine- to a non-zidovudine-containing regimen modestly improves haematological parameters and is not associated with obvious clinical benefit.
Lafaurie
Matthieu
M
Department of Infectious Diseases, Saint-Louis Hospital, University of Paris 7, INSERM U897, 1 avenue Claude Vellefaux 75010 Paris, France.
Collin
Fidéline
F
Bentata
Michele
M
Garré
Michel
M
Leport
Catherine
C
Levy
Yves
Y
Goujard
Cécile
C
Chêne
Geneviève
G
Molina
Jean-Michel
JM
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology; D048588:Benzoxazines / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003521:Cyclopropanes; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016049:Didanosine / Q000627:therapeutic use; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006454:Hemoglobins / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects; D010198:Pancytopenia / Q000139:chemically induced*; D010976:Platelet Count; D015995:Prevalence; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use*
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D006454:Hemoglobins; D003841:Deoxycytidine; D015215:Zidovudine; D000068679:Emtricitabine; C098320:efavirenz; D016049:Didanosine