ArticlePloS one2012
Incidence of treatment-limiting toxicity with stavudine-based antiretroviral therapy in Cambodia: a retrospective cohort study.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Epidemiology of Antiretroviral Therapy Related Adverse Drug Reactions and its Predictors Among Patients with Human Immunodeficiency Virus/AIDS in Ethiopia: A Systematic Review and Meta-analysis.Journal of the International Association of Providers of AIDS CarePooled it
- Causes and determinants of mortality in HIV-infected adults with tuberculosis: an analysis from the CAMELIA ANRS 1295-CIPRA KH001 randomized trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Trial
- Epidermal nerve fiber density, oxidative stress, and mitochondrial haplogroups in HIV-infected Thais initiating therapy.AIDS (London, England) · 2014Trial
- Trial
- Increased risk of Q151M and K65R mutations in patients failing stavudine-containing first-line antiretroviral therapy in Cambodia.PloS one · 2013Trial
- The urgent need for newer drugs in routine HIV treatment in Africa: the case of Ghana.Frontiers in epidemiology · 2025Review
- Evaluation of factors associated with medical male circumcision in South Africa: A case-control study.African journal of primary health care & family medicine · 2022Observational
- Leveraging Experience From Active TB Drug-Safety Monitoring and Management for Monitoring Active Antiretroviral Toxicity.Global health, science and practice · 2022Article
- Regimen durability in HIV-infected children and adolescents initiating first-line antiretroviral therapy in a large public sector HIV cohort in South Africa.Tropical medicine & international health : TM & IH · 2018Article
- Five-year trends in treatment changes in an adult cohort of HIV/AIDS patients in Ghana: a retrospective cohort study.BMC infectious diseases · 2017Article
- Ten year experience with antiretroviral treatment in Cambodia: Trends in patient characteristics and treatment outcomes.PloS one · 2017Article
- Pharmacokinetic, Pharmacogenetic, and Other Factors Influencing CNS Penetration of Antiretrovirals.AIDS research and treatment · 2016Review
- Implementation and Operational Research: Correlates of Adherence and Treatment Failure Among Kenyan Patients on Long-term Highly Active Antiretroviral Therapy.Journal of acquired immune deficiency syndromes (1999) · 2015Article
- Peripheral neuropathy in children on stauvudine therapy.Indian journal of pediatrics · 2015Article
- Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia.PloS one · 2015Article
- HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.Journal of the International AIDS Society · 2015Review
- cART prescription trends in a prospective HIV cohort in rural Tanzania from 2007 to 2011.BMC infectious diseases · 2014Article
- Review
- Increases in regimen durability associated with the introduction of tenofovir at a large public-sector clinic in Johannesburg, South Africa.Journal of the International AIDS Society · 2013Article
- HIV-related neuropathy: current perspectives.HIV/AIDS (Auckland, N.Z.) · 2013Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough stavudine (D4T) remains frequently used in low-income countries in Asia, associated long-term toxicity data are scarce. The aim of this study was to determine the long-term incidence of severe D4T-toxicity (requiring drug substitution) and associated risk factors in HIV-infected Cambodians up to six years on antiretroviral treatment (ART). METHODOLOGY/PRINCIPAL
findingsThis is a retrospective analysis of an observational cohort, using data from an ART program with systematic monitoring for D4T-toxicity. Probabilities of time to D4T substitution due to suspected D4T toxicity (treatment-limiting D4T toxicity) were calculated, a risk factor analysis was performed using multivariate Cox regression modelling. Out of 2581 adults initiating a D4T-containing regimen, D4T was replaced in 276 (10.7%) patients for neuropathy, 14 (0.5%) for lactic acidosis and 957 (37.1%) for lipoatrophy. The main early side effect was peripheral neuropathy (7.0% by 1 year). After the first year, lipoatrophy became predominant, with a cumulative incidence of 56.1% and 72.4% by 3 and 6 years respectively. Older age (aHR 1.8; 95%CI: 1.4-2.3) and lower baseline haemoglobin (aHR 1.7; 95%CI: 1.4-2.2) were associated with the occurrence of neuropathy. Being female (aHR 3.8; 95%CI: 1.1-12.5), a higher baseline BMI (aHR 12.6; 95%CI: 3.7-43.1), and TB treatment at ART initiation (aHR 8.6; 95%CI: 2.7-27.5) increased the likelihood of lactic acidosis. Lipoatrophy was positively associated with female gender (aHR 2.3; 95%CI: 2.0-2.6), an older age (aHR 1.3; 95%CI: 1.1-1.4), and a CD4 count <200 cells/µL (aHR 1.3; 95%CI: 1.1-1.5).
conclusionsStavudine-based treatment regimens in low-income countries are associated with significant long-term toxicities, predominantly lipoatrophy. Close clinical monitoring for toxicity with timely D4T substitution is recommended. Phasing-out of stavudine should be implemented, as costs allows.
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