Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy

Objective: In resource-limited countries, stavudine (d4T) is commonly used as part of the initial highly active antiretroviral therapy (HAART) regimen. Many patients who subsequently develop lipodystrophy switch from d4T to zidovudine (ZDV), a drug that can be myelotoxic. We aimed to study the spect...

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Main Authors: Aurpibul L., Puthanakit T., Sirisanthana T., Sirisanthana V.
Format: Article
Language:English
Published: 2014
Online Access:http://www.scopus.com/inward/record.url?eid=2-s2.0-42049088552&partnerID=40&md5=4cc7941d5433e33a500b755681bc43c9
http://www.ncbi.nlm.nih.gov/pubmed/18331562
http://cmuir.cmu.ac.th/handle/6653943832/2450
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spelling th-cmuir.6653943832-24502014-08-30T02:00:51Z Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy Aurpibul L. Puthanakit T. Sirisanthana T. Sirisanthana V. Objective: In resource-limited countries, stavudine (d4T) is commonly used as part of the initial highly active antiretroviral therapy (HAART) regimen. Many patients who subsequently develop lipodystrophy switch from d4T to zidovudine (ZDV), a drug that can be myelotoxic. We aimed to study the spectrum and severity of haematological changes following this substitution. Methods: This was a retrospective cohort study. The inclusion criteria were as follows: HIV-infected children were included who (1) were 2-15 years old at the time of HAART initiation, (2) had not been diagnosed as having haematological diseases, (3) had been receiving a first HAART regimen consisting of either nevirapine or efavirenz, together with lamivudine and d4T, for at least 48 weeks and (4) had switched from d4T to ZDV at least 48 weeks previously. Results: Seventy-eight children were included in the study. Thirty-six (46%) were male. The mean age was 10.3 years (standard deviation 3.1 years). The switch had been made a median time of 65 weeks (range 48-97 weeks) previously. There was no significant change in CD4 lymphocyte count or percentage, or HIV RNA level, after the switch. There was a statistically significant decrease in haemoglobin level (12.6 vs. 12.1 g/dL; P < 0.001), total white blood cell (WBC) count (8088 vs. 6910 cells/μL; P < 0.001) and absolute neutrophil count (ANC) (4320 vs. 3448 cells/μL; P < 0.001). However, the decreases never reached Division of AIDS grade 3 or 4 severity, and none of the patients had clinical symptoms or signs of anaemia, leukopenia, or neutropenia. No participant had to discontinue ZDV during the 48-week follow-up period. Conclusion: In a paediatric population, statistically significant decreases in haemoglobin level, WBC count and ANC occurred following the substitution of d4T with ZDV, but the magnitudes of the decreases were small and not clinically significant. © 2008 British HIV Association. 2014-08-30T02:00:51Z 2014-08-30T02:00:51Z 2008 Article 14642662 10.1111/j.1468-1293.2008.00560.x 18331562 HMIEA http://www.scopus.com/inward/record.url?eid=2-s2.0-42049088552&partnerID=40&md5=4cc7941d5433e33a500b755681bc43c9 http://www.ncbi.nlm.nih.gov/pubmed/18331562 http://cmuir.cmu.ac.th/handle/6653943832/2450 English
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
language English
description Objective: In resource-limited countries, stavudine (d4T) is commonly used as part of the initial highly active antiretroviral therapy (HAART) regimen. Many patients who subsequently develop lipodystrophy switch from d4T to zidovudine (ZDV), a drug that can be myelotoxic. We aimed to study the spectrum and severity of haematological changes following this substitution. Methods: This was a retrospective cohort study. The inclusion criteria were as follows: HIV-infected children were included who (1) were 2-15 years old at the time of HAART initiation, (2) had not been diagnosed as having haematological diseases, (3) had been receiving a first HAART regimen consisting of either nevirapine or efavirenz, together with lamivudine and d4T, for at least 48 weeks and (4) had switched from d4T to ZDV at least 48 weeks previously. Results: Seventy-eight children were included in the study. Thirty-six (46%) were male. The mean age was 10.3 years (standard deviation 3.1 years). The switch had been made a median time of 65 weeks (range 48-97 weeks) previously. There was no significant change in CD4 lymphocyte count or percentage, or HIV RNA level, after the switch. There was a statistically significant decrease in haemoglobin level (12.6 vs. 12.1 g/dL; P < 0.001), total white blood cell (WBC) count (8088 vs. 6910 cells/μL; P < 0.001) and absolute neutrophil count (ANC) (4320 vs. 3448 cells/μL; P < 0.001). However, the decreases never reached Division of AIDS grade 3 or 4 severity, and none of the patients had clinical symptoms or signs of anaemia, leukopenia, or neutropenia. No participant had to discontinue ZDV during the 48-week follow-up period. Conclusion: In a paediatric population, statistically significant decreases in haemoglobin level, WBC count and ANC occurred following the substitution of d4T with ZDV, but the magnitudes of the decreases were small and not clinically significant. © 2008 British HIV Association.
format Article
author Aurpibul L.
Puthanakit T.
Sirisanthana T.
Sirisanthana V.
spellingShingle Aurpibul L.
Puthanakit T.
Sirisanthana T.
Sirisanthana V.
Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
author_facet Aurpibul L.
Puthanakit T.
Sirisanthana T.
Sirisanthana V.
author_sort Aurpibul L.
title Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
title_short Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
title_full Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
title_fullStr Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
title_full_unstemmed Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy
title_sort haematological changes after switching from stavudine to zidovudine in hiv-infected children receiving highly active antiretroviral therapy
publishDate 2014
url http://www.scopus.com/inward/record.url?eid=2-s2.0-42049088552&partnerID=40&md5=4cc7941d5433e33a500b755681bc43c9
http://www.ncbi.nlm.nih.gov/pubmed/18331562
http://cmuir.cmu.ac.th/handle/6653943832/2450
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