Zidovudine 300mg / Lamivudine 150mg tablets

BackgroundThe WHO recommends antiretroviral therapy (ART) containing two nucleoside reverse transcriptase inhibitors (NRTIs) as backbone. WHO recommends tenofovir disoproxil fumarate combined with lamivudine or emtricitabine as first line in pregnancy, and zidovudine, abacavir or tenofovir alafenamide, combined with lamivudine or emtricitabine, as alternatives.ObjectivesThis study aims to evaluate the risk of adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving different NRTIs.MethodsData sources included Medline, CINAHL, Global Health, and Embase.Study eligibility criteriaCohort studies.ParticipantsPregnant WLHIV.InterventionsART regimens containing different NRTI drugs.Assessment of risk of biasNewcastle-Ottawa Scale and Grading of Recommendations Assessment, Development and Evaluation.Methods of data synthesisRandom-effects meta-analysis.ResultsIn total, 22 cohort studies including 124,478 pregnant WLHIV met the eligibility criteria. ART containing tenofovir disoproxil fumarate was associated with lower risk of preterm birth (risk ratio, 0.89; 95% CI, 0.81-0.97), very preterm birth (0.58; 0.40-0.86), small for gestational age (0.76; 0.59-0.98), very small for gestational age (0.60; 0.48-0.73), stillbirth (0.49; 0.31-0.78), and neonatal death (0.61; 0.40-0.93), compared with ART not containing tenofovir disoproxil fumarate. ART containing zidovudine was associated with an increased risk of very preterm birth (1.59; 1.01-2.49), small for gestational age (1.33; 1.03-1.70), very small for gestational age (1.63; 1.25-2.13), stillbirth (2.23; 1.10-4.55), and neonatal death (1.65; 1.08-2.52), compared with ART not containing zidovudine. For ART regimens also containing either lamivudine or emtricitabine, zidovudine was associated with an increased risk of very preterm birth (1.62; 1.04-2.52), small for gestational age (1.52; 1.28-1.82), very small for gestational age (1.68; 1.36-2.06), stillbirth (2.19; 1.03-4.67), and neonatal death (1.65; 1.08-2.52), compared with ART containing tenofovir disoproxil fumarate. Abacavir was not associated with adverse perinatal outcomes. Tenofovir alafenamide was not associated with low birthweight compared with tenofovir disoproxil fumarate.ConclusionsTenofovir disoproxil fumarate is associated with a lower risk of adverse perinatal outcomes, whereas zidovudine is associated with an increased risk of perinatal outcomes. Abacavir is not associated with adverse perinatal outcomes. Our findings support current WHO guidelines.

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ObjectiveTo evaluate the efficacy and safety of antiretroviral therapy(ART) regimens based on tenofovir(TDF) + lamivudine(3TC) + efavirenz(EFV) in patients co-infected with Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV), thereby providing evidence-based support for clinical treatment decision-making.MethodsRelevant studies published from database inception to March 2025 were systematically retrieved from the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library databases. The revised Risk of Bias tool version 2 (ROB2) was used to assess study quality, and all meta-analyses were performed using Stata 18 software.ResultsA total of 31 randomized controlled trials (RCTs) involving 2124 participants and 12 treatment interventions were included, with four outcome measures evaluated. The network meta-analysis demonstrated that the TDF + 3TC + EFV triple therapy regimen was superior to the other evaluated regimens in achieving higher HBV DNA and HIV RNA negative conversion rates. In addition, TDF+ 3TC + EFV demonstrated greater efficacy than zidovudine(AZT) + 3TC + EFV in increasing CD4 + lymphocyte counts. The surface under the cumulative ranking curve (SUCRA) analysis indicated that TDF + 3TC + EFV ranked highest in terms of efficacy. Regarding safety, several studies reported various types of adverse events. However, no statistically significant differences were observed among the treatment groups.ConclusionBased on the currently available evidence, this network meta-analysis suggests that the TDF + 3TC + EFV triple regimen demonstrates superior efficacy across multiple outcome measures in patients with HIV/HBV co-infection. Nevertheless, owing to the inherent limitations of the included studies, further high-quality studies are required to confirm its role as a preferred therapeutic option.

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IntroductionInitial treatment of the HIV is based on the use of three drugs, two of which are nucleoside analog reverse-transcriptase inhibitors. There are three combinations of these drugs which have been approved by different guidelines, each with divergent results in terms of efficacy and safety.ObjectiveTo compare the efficacy and safety of these three combinations.MethodsSystematic review and network meta-analysis of randomized clinical trials comparing fixed doses of Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC), Abacavir / Lamivudine (ABC/3TC) and Zidovudine / Lamivudine (ZDV/3TC).ResultsSeven clinical trials met the eligibility criteria. The results suggested higher efficacy with TDF/FTC vs. ABC/3TC at 96 weeks and vs. ZDV/3TC at 48 weeks. However, there is clinical and statistical heterogeneity. Subgroup analysis were performed by third drug and by level of viral load prior to treatment, and found no differences in virological control. Network meta-analysis could only be carried out with TDF/FTC vs. ZDV/3TC, and the proportion of patients with virological response, with no differences at 48 weeks nor at 96 weeks. Direct comparisons showed an increased risk of bone marrow suppression of ZDV/3TC vs. TDF/FTC and of ABC/3TC hypersensitivity reactions vs. ZDV/3TC.ConclusionsThe results did not show differences in effectiveness among the interventions. However, due to the heterogeneity of the third drug and the follow-up time between the included studies, this result is not definitive. The results raise the need for further studies to help improve treatment recommendations in patients infected with HIV.

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