Safety of stavudine in the treatment of HIV infection with a special focus on resource-limited settings

Abstract

Background: Western randomized trials and prospective cohorts in resource-limited settings have proven virological success with stavudine-based highly active antiretroviral therapy. However, stavudine is no longer recommended in first-line treatments in these two settings due to its intrinsic toxicities and side effects. Yet it remains a cornerstone of treatment in resource-limited settings, due to lack of alternatives and its availability in generic fixed-dose combinations.

Objective: To review the toxic effects of stavudine and their prevention and management strategies, especially in resource-limited settings.

Methods: Data from clinical and pharmacological trials in Western countries, as well as prospective cohorts in resource-limited settings, were reviewed.

Conclusion: Initiating or switching to less toxic nucleoside analogues whenever possible, or lowering stavudine doses to 30 mg b.i.d., is strongly recommended.