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


CONCLUSIONS
Initiating or switching to less toxic nucleoside analogues whenever possible, or lowering stavudine doses to 30 mg b.i.d., is strongly recommended.
Makinson
Alain
A
University Hospital, Department of Infectious and Tropical Diseases, Montpellier, France.
Moing
Vincent Le
VL
Kouanfack
Charles
C
Laurent
Christian
C
Delaporte
Eric
E
D000140:Acidosis, Lactic / Q000139:chemically induced / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000517:prevention & control; D006295:Health Resources; D006801:Humans; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000517:prevention & control; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D012737:Sex Factors; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine