Published: 2016-12-19

Factors associated with zidovudine substitution in HIV/AIDS patients attending Badung Hospital, Bali, Indonesia between 2006-2014

Sukma Adnyani, Sawitri A. A. S., Wulandari L., Swandewi A., Artawan E. P., Reekie J., Wirawan D. N.


Background: Zidovudine (AZT) is the most commonly used drug in first line antiretroviral therapy (ART) in Indonesia; however, substitution due to its side effect is common. The majority of HIV positive patients in Badung Hospital Bali are treated with AZT yet no longitudinal studies in Bali have investigated the number of substitutions or the factors associated with it.

Methods: A retrospective cohort study of HIV positive persons aged >15 years, receiving AZT between 1st January 2006 – 31st August 2014 was conducted. Persons were included from their date of starting AZT. Cox proportional hazard models were applied to estimate the risk and time to substitution. Substitution was defined as single drug change due to side effects and initiating another drug of the same class.

Results: During our study 260 patients started AZT, of which 77 (29.6%) experienced substitution. The risk of substitution was 19 per 100 person years. Of those 77, the median time to AZT substitution was 69 days (IQR 25-178). Factors significantly associated with an increased risk of AZT substitution included women (HR 1.79; 95% CI 1.09-2.94), having low hemoglobin levels <10g% (HR 2.72; 95% CI 1.02-7.21), clinical stage III and IV (HR 3.53; 95% CI 1.26-6.19) at the time of starting AZT, and starting ART after 2012 (HR 3.83; 95% CI 2.19-6.70).

Conclusions: Present study identified individuals that may be at a high risk of AZT substitution who should be monitored more closely or consideration given to initiating them on another treatment regimen.

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UNAIDS. UNAIDS World AIDS Day Report 2012. 2012.

Kemenkes. Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada orang Dewasa. 2011.

Report HM. HIV AIDS Progress Report Second Quarter, 2014. 2014;2.

Phe T, Thai S, Veng C, Sok S, Lynen L, van Griensven J. Risk factors of treatment-limiting anemia after substitution of zidovudine for stavudine in HIV-infected adult patients on antiretroviral treatment. PLoS One. 2014;8(3):e60206.

Velen K, Lewis JJ, Charalambous S, Grant AD, Churchyard GJ, Hoffmann CJ. Comparison of tenofovir, zidovudine, or stavudine as part of first-line antiretroviral therapy in a resource-limited-setting: a cohort study. PLoS One. 2014;8(5):e64459.

Jarrett OD, Wanke CA, Ruthazer R, Bica I, Isaac R, Knox TA. Metabolic syndrome predicts all-cause mortality in persons with human immunodeficiency virus. AIDS Patient Care STDS. 2013;27(5):266-71.

Willig JH, Echevarria J, Westfall AO, Iglesias D, Henostroza G, et al. No Title. Durab Initial Antiretrovir Ther a Resour setting potential need zidovudine Weight dosing. J Acquir. 2010;1:215-21.

Sumantri R, Wicaksana R, Ariantana AR, Supandiman IP. Anemia in Patients with HIV-AIDS in Teratai Policlinic Hassan Sadikin Hospital-Bandung Province. 2009;10(3).

Boulle A, Orrell C, Kaplan R, Cutsem G Van, Mcnally M, Town C, et al. Substitutions due to antiretroviral toxicity or contraindication in the first 3 years of antiretroviral therapy in a large South African cohort. 2007;753-60.

Wibawa KR, Merati TP, Somia ASU. Factors Related to Macrocytosis in Patient HIV/AIDS with Zidovudine Therapy in Sanglah General Hospital. 2010;11.

Sullivan BPS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project. 2015.

Agarwal D, Chakravarty J, Chaube L, Rai M, Agrawal NR, Sundar S. High incidence of zidovudine induced anaemia in HIV infected patients in eastern India. Indian J Med Res. 2010;132:386-9.

Curkendall SM, Richardson JT, Emons MF, Fisher AE, Everhard F. Incidence of anaemia among HIV-infected patients treated with highly active antiretroviral therapy. HIV Med. 2007;8(8):483-90.

Spiritia Y. AZT (Zidovudine) [Internet]. 2014. Available from: li/ bacali.php?lino=411

Nasronudin. HIV and AIDS Pendekatan Biologi Molekuler, Klinis, dan Sosial. Surabaya: Airlangga University Press. 2007.