Stavudine plus a non-thymidine nucleoside reverse transcriptase inhibitor as a backbone for highly active antiretroviral therapy.
Current guidelines for treatment of human immunodeficiency virus (HIV) disease favour the use of triple-drug combinations consisting of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor to achieve maximum suppression of HIV replication. There is considerable evidence for including one thymidine NRTI to target activated HIV host cells and one non-thymidine NRTI to target quiescent host cells as the backbone of such regimens. A number of recent studies have shown that stavudine in combination with didanosine or lamivudine is at least as effective as zidovudine-based combinations with regard to virological outcomes, with available data suggesting an enhanced effect on immunological outcome with stavudine-based combinations. When considered along with such advantageous characteristics of stavudine as infrequent and low-level resistance and good cerebrospinal fluid penetration, these findings indicate that stavudine in combination with didanosine or lamivudine should be considered for use as the backbone of multiple-agent highly active antiretroviral therapy (HAART).
Clumeck
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Department of Internal Medicine, Division of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium. crmiclum@ulb.ac.be
D002986:Clinical Trials as Topic; D016049:Didanosine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D012190:Retroviridae / Q000187:drug effects; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D018119:Stavudine / Q000627:therapeutic use*; D015215:Zidovudine / Q000627:therapeutic use*
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D018119:Stavudine; D016049:Didanosine