Immunological outcomes between Tenofovir versus Zidovudine-based regimens: a retrospective cohort study
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Abstract
Background: Since 2013, Tenofovir (TDF) and Zidovudine (AZT) based regimen are alternatively used as a first line for treatment of HIV in Tanzania. CD4+ cells count, which is recommended after every six months monitors the immunological progression, and used as one of the indicators of treatment progression. However, there is little literature available information to compare the immunological outcomes of these two regimens.
Methods: A hospital-based retrospective cohort study was conducted at Muhimbili National Hospital, Care and Treatment Clinic (MNH-CTC) in Dar es Salaam. HIV/AIDS patients’ files of October 2012 through November 2016 were reviewed. Using statistical package for social sciences (SPSS version 23), the mean CD4+ cells count were compared by independent t-test while Chi-square test was performed to associate categorical variables. Binary logistic regression was used to control variables such as sex and body mass index (BMI). The results were considered having statistical significance when the P < 0.05.
Results: Overall 340 patients’ files were eligible and reviewed. Of 340 patients, 50% (170) patients were on TDF. Most of the patients on TDF (64.4%) and AZT (62.5%) were female where 69.4% on TDF and 65.3% on AZT were at the age group between 25-45 years. Majority of patients 94% and 89% on TDF and AZT respectively had BMI ≥ 18.5 kg/m2.
Most of the patients on TDF 54% (170) had a baseline CD4+ counts between 250-600 cells/mm3 and AZT 58% (170) had CD4+ counts <250 cells/mm3. In 12 months post antiretroviral (ARV) initiation, the mean (±SD) CD4+ counts gain in TDF regimen was higher 455.8(165.8) than that in AZT regimen 383.4 (90.6) (p<0.001). Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) recorded the highest mean gain [standard deviation (±SD)] CD4+ counts of 476.5(190.3) followed by Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP);435.2 (134.9), TDF/3TC/NVP; 450.5 (201.9) and AZT/3TC/EFV; 316.4 (152.4).
Conclusion: Twelve months post ARV initiation; TDF based regimens had good immunological outcomes compared to AZT based regimens. Generally, TDF/3TC/EFV is the regimen that demonstrated highest mean CD4+ counts while AZT/3TC/EFV recorded the lowest mean CD4+, cells count.
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