Beschreibung:
<jats:sec><jats:title>Objectives</jats:title><jats:p>The long‐term side effects of stavudine (d4<jats:styled-content style="fixed-case">T</jats:styled-content>) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients taking combination antiretroviral therapy (<jats:styled-content style="fixed-case">cART</jats:styled-content>) in <jats:styled-content style="fixed-case">EuroSIDA</jats:styled-content> with follow‐up after 1 <jats:styled-content style="fixed-case">J</jats:styled-content>anuary 2006 were included in the study. <jats:styled-content style="fixed-case">cART</jats:styled-content> was defined as <jats:styled-content style="fixed-case">d4T</jats:styled-content>‐containing [<jats:styled-content style="fixed-case">d4T</jats:styled-content> plus at least two other antiretrovirals (<jats:styled-content style="fixed-case">ARVs</jats:styled-content>) from any class] or non‐<jats:styled-content style="fixed-case">d4T</jats:styled-content>‐containing (at least three <jats:styled-content style="fixed-case">ARVs</jats:styled-content> from any class, excluding <jats:styled-content style="fixed-case">d4T</jats:styled-content>). Poisson regression was used to describe temporal changes in the prevalence of <jats:styled-content style="fixed-case">d4T</jats:styled-content> use and factors associated with initiating <jats:styled-content style="fixed-case">d4T</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 5850 patients receiving <jats:styled-content style="fixed-case">cART</jats:styled-content> on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) 19–20%]. d4T use declined fastest in <jats:styled-content style="fixed-case">N</jats:styled-content>orthern <jats:styled-content style="fixed-case">E</jats:styled-content>urope [26% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 23–29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16–19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio (<jats:styled-content style="fixed-case">aIRR</jats:styled-content>) 0.86; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.80–0.91]. Factors associated with initiating <jats:styled-content style="fixed-case">d4T</jats:styled-content> were residence in <jats:styled-content style="fixed-case">E</jats:styled-content>astern <jats:styled-content style="fixed-case">E</jats:styled-content>urope (<jats:styled-content style="fixed-case">aIRR</jats:styled-content> 4.31; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 2.17–9.98) versus other European regions and <jats:styled-content style="fixed-case">HIV RNA</jats:styled-content> > 400 copies/mL (<jats:styled-content style="fixed-case">aIRR</jats:styled-content> 3.11; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.60–6.02) versus <jats:styled-content style="fixed-case">HIV RNA</jats:styled-content> < 400 copies/mL.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:styled-content style="fixed-case">d4T</jats:styled-content> use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of <jats:styled-content style="fixed-case">d4T</jats:styled-content> use remains in <jats:styled-content style="fixed-case">E</jats:styled-content>astern <jats:styled-content style="fixed-case">E</jats:styled-content>urope, where new <jats:styled-content style="fixed-case">d4T</jats:styled-content> initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating <jats:styled-content style="fixed-case">HIV</jats:styled-content>‐positive patients are aware of the potential harmful effects associated with d4T.</jats:p></jats:sec>