Prevalence of anemia from a systematic substitution of Zidovudine for Stavudine-based HAART in a program setting in Phan Hospital, Chiangrai

Background : National guidelines on HIV/AIDS diagnosis and treatment:Thailand 2006/2007 recommened to use two NRTI plus one NNRTI for initial firstline standard HAART regimen, mostly GPO-VIR S (d4T + 3TC + NVP) was prefered because easy to use, low short-term toxicity, high efficacy, has generic drug, low-cost and fixed-dose combinations that enhances patient adherence. There was increasing evidence that d4T associated with longterm side effect especially on lipoatrophy / lipodystrophy or peripheral neuropathy and then zidovudine (AZT) was widely substituted. Afterthat, there was increasing in the incidence of anemia from AZT. Objective : To evaluate prevalence of anemia and identify risk factor that associated with anemia from a systematic substitution of Zidovudine for Stavudinebased HAART in a program setting in Phan Hospital, Chiangrai. Methods : This was a retrospective, observational study using data routinely collected at each follow-up during January 2006 to September 2010. The data were recorded at time of switch from d4T to AZT-based HAART. Results : Among 185 patients systematically switched to AZT-based regimen within 1 year after the switch, 29 patients (15.7 percent) developed anemia, mostly mild anemia (grade 1) 19 patients (10.3 percent), inferior to critical anemia (grade 4) 8 patients (4.3 percent), and moderate anemia (grade 2) 2 patients (1.1 percent). The median time after switching to AZT-based regimen until developing anemia. was 20 weeks ( Interquartile Range: IQR = 12.0 - 28.0 weeks). The data analysis found that female sex had statistically significant risk factor to developing anemia in this study (p < 0.05) Conclusion : The prevalence of anemia from a systematic substitution of Zidovudine for Stavudine-based HAART in a program setting in Phan Hospital, Chiangrai was 15.7 percent and the data analysis found that female sex had statistically significant risk factor to developing anemia in this study (p < 0.05). Keywords : Zidovudine, Stavudine, anemia, highly active antiretroviral treatment (HAART)