title: cART prescription trends in a prospective HIV cohort in rural Tanzania from 2007 to 2011.
abstract: BACKGROUND
  Since 2010, World Health Organization (WHO) guidelines discourage using stavudine in first-line regimens due to frequent and severe side effects. This study describes the implementation of this recommendation and trends in usage of antiretroviral therapy combinations in a cohort of HIV-positive patients in rural Tanzania.
  
  
  METHODS
  We analyzed longitudinal, prospectively collected clinical data of HIV-1 infected adults initiating antiretroviral therapy within the Kilombero Ulanga Antiretroviral Cohort (KIULARCO) in Ifakara, Tanzania from 2007-2011.
  
  
  RESULTS
  This analysis included data of 3008 patients. Median age was 38 (interquartile range [IQR] 31-45) years, 1962 (65.2%) of all subjects were female, and median CD4+ cell count at enrollment was 168 cells/mm3 (IQR 81-273). The percentage of prescriptions containing stavudine in initial regimens fell from a maximum of 75.3% in 2008 to 10.7% in 2011. TDF/FTC/EFV became available in 2009 and was used in 41.9% of patients initiating cART in 2011. An overall on-treatment analysis revealed that d4T/3TC/NVP and AZT/3TC/EFV were the most prescribed combinations in each year, including 2011 (674 [36.5%] and 641 [34.7%] patients, respectively). Of those receiving stavudine in 2011, 659 (89.1%) initiated it before 2011.
  
  
  CONCLUSIONS
  Initial cART with stavudine declined to low levels according to recommendations but the overall use of stavudine remained substantial, as individuals already on cART containing stavudine were not changed to alternative drugs. Our findings highlight the critical need to exchange stavudine in treatment regimens of patients who initiated therapy in earlier years.
authors.affiliation: Swiss Tropical and Public Health Institute (SwissTPH), Socinstrasse 57, CH-4051 Basel, Switzerland. fcfranzeck@gmail.com.
authors.forename: Fabian Christoph
authors.initials: FC
authors.lastname: Franzeck
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mwaigomole
authors.forename: Boniphace
authors.initials: B
authors.lastname: Jullu
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Glass
authors.forename: Daniel
authors.initials: D
authors.lastname: Nyogea
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012424:Rural Population; D018119:Stavudine / Q000627:therapeutic use*; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents; D018119:Stavudine