Safe substitution to zidovudine among HIV-infected patients initiated on stavudine-containing highly active antiretroviral therapy from a resource-limited setting

SummaryObjectiveTo describe the safe substitution with zidovudine (AZT) among South Indian HIV-infected patients who were initiated with stavudine (d4T)-containing highly active antiretroviral therapy (HAART) due to anemia.MethodsTherapy-naïve patients initiating HAART between January 2006 and December 2007 and who had had d4T substituted for AZT at a tertiary HIV referral center in India were analyzed.ResultsSix hundred and nineteen patients initiated d4T-containing HAART (median CD4 110 cells/μl; median hemoglobin 10.4 g/dl) during the study period. Subsequently half of these patients substituted d4T for AZT (median CD4 350 cells/μl; median hemoglobin 12.8 g/dl). After substituting with AZT, three patients (2.7%) who substituted after less than 6 months and one patient (0.6%) who substituted at between 6 and 12 months developed anemia. Patients who substituted after less than 6 months had significantly higher median CD4 cell counts at 1-month and 6-months of follow-up than patients who substituted at between 6 and 12 months (p < 0.05). Few patients (1.6%) experienced treatment failure; about a tenth of patients developed d4T-related toxicities.ConclusionFew patients developed anemia (1.4%) within 6 months of substitution with AZT. In settings where tenofovir is either expensive or not available and where patients are anemic, initiating d4T followed by prompt substitution with AZT can be a safe and tolerable treatment option.