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Phasing out use of d4T in Cambodia

In the National Pediatric Hospital in Phnom Penh, Dr. Chel Sarim, on behalf HIV Flagship (KHANA, FHI 360, and PSI); and Dr. Men Pagnaroat, AIDS Health Foundation, said that d4T that has been used to treat people who are living with HIV in Cambodia is switched to TDF for HIV-adult patients and AZT for HIV children.

Approximately 90 participants from 17 Pre-ART and ART sites in Phnom Penh, Kandal and Kampong Speu province including KHANA attended the Orientation Workshop on Switching Protocol for Phasing out the User of D4T among HIV Patient on ART in Cambodia on 27 November 2013.

Clinical Benefits

Dr. Chel Sarim and Dr. Men Pagnaroat, on behalf of  the Technical Working Group of the National Center for HIV/AIDS, Dermatology and STD (NCHADS), said long-term toxicities with d4T are common and some are very serious. Alternative regimens, such as TDF and AZT have been shown to cause fewer long-term toxicities.

Patient Benefits

For adults, the recommended alternative of TDF has a lower pill burden. Simpler, less toxic regimens lead to better adherence, and this improves treatment outcomes.

Programme Benefits

Better adherence prevents drug resistance from developing and reduces the need for more complex, expensive second-line regimens.

NCHADS presented that d4T can reduce patients’ second line treatment options because it can cause the accumulation of thymidine analogue mutations (TAMs). In contrast, TDF does not cause TAMs accumulation, so it does not compromise AZT as a second line treatment option.

The workshop concluded that the estimated changes in patient numbers who will be switched from d4T to TDF or AZT would be implemented from December 2013 upon the quarterly ARV request to NCHADS. 

Prof. Eng Huot, Secretary of State, Ministry of Health, signed the Switching Protocol for Phasing Out The User of d4T among HIV Patient on ART in Cambodia on 25 November 2013, saying he is confident that all concerned stakeholders would follow and support the implementation of the protocol to ensure that Cambodian HIV-infected patients are offered with optimal ART regiment associated with better tolerability and patient outcomes in the long-term.

By Mey Sovannara

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