Abstract:
Tenofovir (TDF) based regimen was reported to have better immunological outcomes. Unfortunately,
there is limited information regarding the immunologic outcome associated with this regimen in Ethiopia, as its routine utilization in this setting begun since 2013.
Methods: A 2 years retrospective cohort study was conducted at Jimma University Specialized Hospital, 346 km
Southwest of Addis Ababa, Ethiopia. A total of 280 patients’ data from September 2012 to July 2014 was extracted
from records from February 10, 2015 to March 10, 2015. Records were selected using a simple random sampling technique. Data on socio-demographic, clinical and drug related variables were collected; entered into EpiData 3.1 and
analyzed by STATA 13.1. Mixed effect linear regression was performed to assess difference in CD4+ change between
groups adjusting for baseline characteristics. The change in predicted CD4 count attributed to each regimen was also
assessed by marginal analysis. P < 0.05 for slopes of the random effect linear regression was used as indicators for
presence of association.
Results: The mean (SD) duration of cohort follow up was 714.2 (69.6) and 708.8 (78.9) days (P = 0.753) for TDF and
AZT groups respectively. The minimum follow up duration was 7.4 and 8.9 months for TDF and AZT groups respectively. Most of TDF (93.6%) and AZT (91.4%) groups completed their follow up, 5 (3.6%) TDF and 6 (4.3%) AZT groups
died and 4 (2.9%) TDF and 6 (4.3%) AZT groups were lost for follow-up (P = 0.769). There was statistically significant
difference in immunologic recovery between the groups (B = +34.08, 95% CI [7.8, 60.35], P = 0.027) over time. The
predicted CD4+ count for TDF/3TC/EFV was (B = +347.65 cells/mm3
, P < 0.001) whereas that of AZT/3TC/EFV was
(B = +281.54 cells/mm3
, P < 0.001).
Conclusions: TDF based regimens have shown more efficacy compared to AZT based regimens though AZT based
regimens are more affordable in low income countries like Ethiopia. However, we recommend further study with
quality design to assess the prevalence of sub-optimal CD4+ response (net CD4 gain <50 cells/µl/6 month) in this
set-up among TDF users.
