Treatment outcomes of Tenofovir and Zidovudine-based regimens among people living with HIV/AIDS at Jimma University Specialized Hospital, Southwest Ethiopia

Abstract

: Tenofovir (TDF) based regimen is one of the first line agent that is being utilized routinely since 2013 in Ethiopia. Unfortunately, there is limited information regarding the major treatment outcome measures such as: rate of CD4+ recovery, mortality and the incidence of opportunistic infections; of TDF based regimens compared with Zidovudine (AZT) based regimens. Objective: To compare treatment outcomes of Tenofovir and Zidovudine based antiretroviral (ART) regimens among people living with HIV/AIDS at Jimma University Specialized Hospital, Southwest Ethiopia. Methods: A two year retrospective cohort study was conducted from February 10/2015 to March 10/2015 at Jimma University Specialized Hospital. Atotal of 280 records were reviewed by selecting records using a simple random sampling technique. Data was collected on socio-demographic, clinical characteristics of patients and drug related variables. Data was entered into EpiData version 3.1 for cleaning and analyzed using STATA 13.1. Kaplan-Meier and Cox regression was used to compare treatment outcome and identify independent predictors of treatment outcome. Hazard ratio was used as measure strength of association and p-value of <0.05 was considered to declare statistical significance. Predictors for CD4+ change were identified with mixed effect linear regression analysis. Slopes of the random effect linear regression and their 95% confidence intervals together with p-value < 0.05 was used as indicators for presence of association. Results: Of 280 patients, 183(65.36%) were female. Of these females, 93(33.32%) belongs to Tenofovir group. The mean age of the study subjects was 32.31 + 8.32 years. Through 24 months analysis, TDF based regimen had a protective effect against death and opportunistic infections (OIs), (AHR=0.79, 95% CI [0.24, 2.62]) and (AHR=0.78, 95%CI [0.43, 1.4] respectively. The average opportunistic infection treatment effect of TDF/3TC/EFV was (-71/1000, p=0.026), while it was (+114/1000, p=0.049) for AZT/3TC/EFV. However, TDF/3TC/NVP was associated with statistically insignificant morbidity reduction (-74/1000, p=0.377). Those with body mass-index (BMI) <18.5kg/m2 (AHR=3.21, 95%CI [0.93, 11.97]) had higher hazard of death. Absence of baseline prophylaxis (AHR=8.22, 95% CI [1.7, 39.77]), Cotrimoxazole prophylaxis alone (AHR=6.15, 95% CI [1.47, 26.67]) and BMI<18.5kg/m2 (AHR=2.06, 95% CI [1.14, 3.73]) had higher hazards of OIs.TDF group had shown potentially promising immunologic recovery (β =+34.08, 95% CI [7.8, 60.35], p=0.001) over time. And the predicted CD4+ count for TDF/3TC/EFV had (β = +347.65 cells/mm3 , p<0.001) change. Conclusion and recommendations: TDF based combinations were promising regimens to be used in this setup interms of suppressing opportunistic infections and immunologic recovery. However, the mortality benefit and prevalence of sub-immunologic (SO-CD4) response among the users remained uncertain.