title: A farewell to didanosine: harm reduction and cost savings by eliminating use of didanosine.
abstract: Didanosine (ddI) is a nucleoside reverse transcriptase inhibitor associated with adverse events and public health concerns which have diminished its place in HIV clinical practice, particularly in resource-rich settings. While international guidelines do not contain ddI-containing regimens in preferred first- or second-line antiretroviral therapy (ART), there is no guidance for management of patients currently on ddI. In 2012 at least 20 countries purchased a total of $1-2 million of ddI. Drug purchase data in that year show 3.2-10.3 times higher costs for ddI compared to lamivudine (3TC). Given issues of multiple toxicities, monitoring, drug interactions, inconvenience, and virologic efficacy, as well as cost and formulary concerns, national (including resource-limited setting) ART programmes should consider complete phase-out of ddI.
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA esv8@cdc.gov.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dziuban
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Raizes
authors.affiliation: Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, GA, USA.
authors.forename: Emilia H
authors.initials: EH
authors.lastname: Koumans
mesh_terms: D017046:Cost Savings; D016049:Didanosine / Q000009:adverse effects* / Q000191:economics; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D015658:HIV Infections / Q000188:drug therapy*; D040261:Harm Reduction; D006801:Humans; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000191:economics; D016896:Treatment Outcome
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D016049:Didanosine
keywords: AIDS; Didanosine; HIV; antiretroviral therapy; drug interactions; drug toxicity; reverse transcriptase inhibitors; treatment