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You searched for subject:( Stavudine d4T ). Showing records 1 – 3 of 3 total matches.

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Boston University

1. Brennan, Alana Teresa. Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa.

Degree: PhD, Epidemiology, 2016, Boston University

The success of scale up of antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is in large part due to the introduction of a “public health approach” to access advocated by the World Health Organization (WHO) which emphasized standardized treatment regimens that could be purchased in large quantities and delivered at scale. In 2010 the WHO updated their global HIV treatment guidelines recommending the substitution of stavudine with tenofovir (both of which are members of the non-nucleoside reverse transcriptase inhibitor (NRTI) class of drugs) in first-line antiretroviral therapy (ART). Given the size of treatment programs in sub-Saharan Africa, changing the NRTI used in first-line therapy for HIV could have a substantial impact on treatment outcomes. We conducted three prospective cohort studies using clinical datasets from several sub-Saharan African countries to answer questions surrounding the impacts of exposure to tenofovir in first-line therapy. The first study examines the frequency of stavudine use and single-drug substitutions (substituting the NRTI in first-line ART) in three regions in sub-Saharan Africa by calendar year, 2004–2014. We found a total of 33,441 (8.9%; 95% CI: 8.7–8.9%) single-drug substitutions occurred among 377,656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in single-drug substitutions corresponded with the phasing out of stavudine. We saw an 80% reduction in the risk of single-drug substitutions when comparing tenofovir to stavudine and close to a 70% reduction in the risk when comparing zidovudine to stavudine. The second study uses a regression discontinuity design to evaluate the impact of national HIV treatment guideline changes in South Africa and Zambia recommending tenofovir in first-line ART on treatment outcomes. We found that updated WHO guidelines increased the proportion of patients initiating tenofovir (risk difference (RD) (South Africa): 81%; 95% CI: 73%, 89%; RD (Zambia): 42%; 95% CI: 38%, 45%). Intent to treat estimates showed a decrease in single-drug substitutions in South Africa (RD: -15%; 95% CI: -18%, -12%) and Zambia (RD: -2.0%; 95% CI: -3.6%, -0.3%). In both countries, there was no effect on mortality, attrition or viral load failure (South Africa only). The third study investigates the effect of the 2012 tenofovir stock shortage in South Africa on provider and patient level outcomes, using data from four public-sector Right to Care clinics, two of which experienced a tenofovir stock shortage and two that did not. While imprecise, our results suggest a potential shift in how providers managed patients during the period of the shortage, mainly, a noticeable decrease in the average number of days between visits during the shortage compare to before or after at all four clinics and a significant difference in the proportion of patients missing visits. Difference-in-difference regression results showed a small, but significant, increase in the risk of missed visits during…

Subjects/Keywords: Epidemiology; HIV; Stavudine; Sub-Saharan Africa; Tenofovir; Zidovudine

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Brennan, A. T. (2016). Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa. (Doctoral Dissertation). Boston University. Retrieved from http://hdl.handle.net/2144/19521

Chicago Manual of Style (16th Edition):

Brennan, Alana Teresa. “Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa.” 2016. Doctoral Dissertation, Boston University. Accessed May 06, 2021. http://hdl.handle.net/2144/19521.

MLA Handbook (7th Edition):

Brennan, Alana Teresa. “Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa.” 2016. Web. 06 May 2021.

Vancouver:

Brennan AT. Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa. [Internet] [Doctoral dissertation]. Boston University; 2016. [cited 2021 May 06]. Available from: http://hdl.handle.net/2144/19521.

Council of Science Editors:

Brennan AT. Shifting to tenofovir use in first-line antiretroviral therapy for HIV-positive adults in public sector treatment programs in sub-Saharan Africa. [Doctoral Dissertation]. Boston University; 2016. Available from: http://hdl.handle.net/2144/19521


Stellenbosch University

2. Imran, Syed Ali. The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng.

Degree: MMed, Interdisciplinary Health Sciences, 2011, Stellenbosch University

Objective To determine the reasons for the change or modification in the first line HAART regimen (1a and 1b) in HIV positive patients at the Thusong CCMT site. Methods This study is a quantitative descriptive study using a standardized data collection tool to extract retrospective data from medical records. Subjects Subjects for this study included patients 18 years or older attending the Thusong CCMT site, which were started on HAART regimens 1a or 1b and were on treatment for at least 6 months. The final sample size evaluated was 257 patients. Results There was a high rate (43%) of change or modification of the first line HAART regimen. Majority of the patient’s (72%) had their regimen modified due to side effects of the drugs and only a small number (9.7%) of patients had a complete change in the regimen due to virological failure. Stavudine (d4T) associated lipodystrophy was the most common side effect (45.5%) followed by peripheral neuropathy (16.7%), leading to treatment modification. Conclusion The rate of modification or change of first line HAART regimen, at Thusong CCMT, was fairly high (42.6%), and the most common reason for the modification or change was drug side effect of stavudine (d4T). Advisors/Committee Members: Gunst, Colette, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences..

Subjects/Keywords: HIV positive persons  – Treatment; Highly active antiretroviral therapy (HAART); Stavudine  – Side effects; UCTD; UCTD

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Imran, S. A. (2011). The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng. (Thesis). Stellenbosch University. Retrieved from http://hdl.handle.net/10019.1/97249

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Imran, Syed Ali. “The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng.” 2011. Thesis, Stellenbosch University. Accessed May 06, 2021. http://hdl.handle.net/10019.1/97249.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Imran, Syed Ali. “The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng.” 2011. Web. 06 May 2021.

Vancouver:

Imran SA. The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng. [Internet] [Thesis]. Stellenbosch University; 2011. [cited 2021 May 06]. Available from: http://hdl.handle.net/10019.1/97249.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Imran SA. The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng. [Thesis]. Stellenbosch University; 2011. Available from: http://hdl.handle.net/10019.1/97249

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation


Stellenbosch University

3. Innes, Steven Eugene Vere. Lipoatrophy in HIV-infected children on antiretroviral therapy.

Degree: PhD, Paediatrics and Child Health, 2013, Stellenbosch University

Bibliography

ENGLISH ABSTRACT: Introduction: Lipoatrophy is a common adverse effect of stavudine and this effect is strongly dose-dependent. Stavudine remains the most commonly used paediatric antiretroviral drug in sub-Saharan Africa, yet when the current study began in 2009, the prevalence and severity of lipoatrophy in children on antiretroviral therapy in sub-Saharan Africa had never been studied. The development of lipoatrophy may have serious and far-reaching consequences for patients and their families. The off-label stavudine dosing method, prescribed to children whose caregivers do not have access to a refrigerator, in which the contents of an adult capsule is mixed into tap water, has potential for over-dosing or under-dosing. In addition, children on stavudine continue to be exposed to a disproportionately high dose out of line with the reduced adult dose. Aims: 1. a) To investigate the prevalence and risk factors for lipoatrophy in HIV-infected children in Southern Africa b) To identify a simple anthropometric screening tool to detect early lipoatrophy in children 2. To validate the off-label stavudine dosing method prescribed to children whose caregivers do not have access to a refrigerator, with a view to reducing the recommended dose and thereby the side-effects. Methods: 1. a) We recruited pre-pubertal children on antiretroviral therapy from a family HIV clinic in our facility. Lipoatrophy was identified by two experienced paediatric HIV clinicians using a standardized grading scale. A dietician performed dietary assessment and anthropometric measurements. Previous antiretroviral exposures were recorded. A subset of recruits received Dual-Energy X-ray Absorbtiometry scanning. b) Anthropometric measurements in children with and without lipoatrophy were compared using multivariate linear regression adjusting for age and gender. The most discerning anthropometric variables underwent Receiver Operating Characteristic curve analysis to identify the most appropriate diagnostic cut-off. 2. a) Accuracy of the standard off-label stavudine dosing method was investigated using high-performance liquid chromatography to recover active drug from solutions made up using the prescribed method. This was compared to the stated drug content of the capsules. b) Bioavailability was investigated by performing a randomized crossover pharmacokinetic study wherein healthy HIV-seronegative adult volunteers received one of two generic stavudine capsule formulations, either intact or mixed in water using the prescribed method. Plasma stavudine concentrations were assayed by liquid chromatography tandem mass spectrometry. Results: 1. a) Prevalence of lipoatrophy was 36%, and incidence was 12% per person-year. Adjusted odds ratio for developing lipoatrophy was 1.9 (CI: 1.3–2.9) for each additional year of accumulated exposure to standard-dose stavudine. b) Baseline biceps skin-fold thickness correlated well with maximum lipoatrophy grading score at any site, giving a partial correlation coefficient of 0.33…

Advisors/Committee Members: Cotton, Mark Fredric, Rosenkranz, Bernd, Rabie, Helena, Zollner, Ekkehard Werner, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health..

Subjects/Keywords: Pediatrics; Dissertations  – Pediatrics; Lipoatrophy  – HIV-positive children  – Risk factors; HIV positive children  – Treatment; Antiretroviral agents  – Risk factors; Stavudine  – Therapeutic use; Pediatrics and Child Health

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Innes, S. E. V. (2013). Lipoatrophy in HIV-infected children on antiretroviral therapy. (Doctoral Dissertation). Stellenbosch University. Retrieved from http://hdl.handle.net/10019.1/79864

Chicago Manual of Style (16th Edition):

Innes, Steven Eugene Vere. “Lipoatrophy in HIV-infected children on antiretroviral therapy.” 2013. Doctoral Dissertation, Stellenbosch University. Accessed May 06, 2021. http://hdl.handle.net/10019.1/79864.

MLA Handbook (7th Edition):

Innes, Steven Eugene Vere. “Lipoatrophy in HIV-infected children on antiretroviral therapy.” 2013. Web. 06 May 2021.

Vancouver:

Innes SEV. Lipoatrophy in HIV-infected children on antiretroviral therapy. [Internet] [Doctoral dissertation]. Stellenbosch University; 2013. [cited 2021 May 06]. Available from: http://hdl.handle.net/10019.1/79864.

Council of Science Editors:

Innes SEV. Lipoatrophy in HIV-infected children on antiretroviral therapy. [Doctoral Dissertation]. Stellenbosch University; 2013. Available from: http://hdl.handle.net/10019.1/79864

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