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Hematologic Changes Associated With Zidovudine Following Single-Drug Substitution From Stavudine in a Home-Based AIDS Care Program in Rural Uganda

Global AIDS Program, National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia

David Moore, MD, MHSc, FRCP

Global AIDS Program, NCHSTP, CDC, Uganda, Uganda Virus Research Institute, Entebbe, Uganda, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Jonathan Mermin, MD, MPH

Global AIDS Program, NCHSTP, CDC, Uganda, Uganda Virus Research Institute, Entebbe, Uganda, Global AIDS Program, National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia

John T. Brooks, MD

Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia

Willy Were, MBChB, MSc

Global AIDS Program, NCHSTP, CDC, Uganda, Uganda Virus Research Institute, Entebbe, Uganda

Kate Buchacz, PhD

Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia

James D. Campbell, MD, MS

Global AIDS Program, NCHSTP, CDC, Uganda, Uganda Virus Research Institute, Entebbe, Uganda, Global AIDS Program, National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia

Robert Downing, PhD

Global AIDS Program, NCHSTP, CDC, Uganda, Uganda Virus Research Institute, Entebbe, Uganda

Craig B. Borkowf, PhD

Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia

Paul J. Weidle, PharmD, MPH

Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia, pweidle{at}cdc.gov

Background. The authors evaluated hematologic changes associated with zidovudine (ZDV) following single-drug substitution from stavudine (D4T) in HIV-infected persons in Uganda. Methods. From May 2003 through February 2007, the authors evaluated incidence rates (IR) of hematologic abnormalities from quarterly blood draws among adults prescribed highly active antiretroviral therapy (HAART) before and after single-drug substitution of D4T to ZDV. Results. A total of 1089 adults received D4T-containing HAART (median observation time, 35.9 months), and 290 (27%) had ZDV substituted for D4T. While taking D4T, IR for anemia was 0.35/100 person-months (PMs), leukopenia was 0.29/100 PM, and thrombocytopenia was 0.32/100 PM. While taking ZDV, IR for anemia was 0.44/100 PM, leukopenia was 1.05/100 PM, and thrombocytopenia was 0.30/100 PM. Conclusions. Patients had a higher incidence of anemia and leukopenia after substitution from D4T to ZDV, but hematologic toxicity was not a major complication in this population. Patients on ZDV-containing HAART regimens are still at risk for anemia and need close monitoring.

Key Words: antiretroviral therapy • toxicity • zidovudine • Africa • Uganda • rural

This version was published on March 1, 2009

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 8, No. 2, 128-138 (2009)
DOI: 10.1177/1545109709333081


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