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.
MeSH terms
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Acidosis, Lactic / chemically induced
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Acidosis, Lactic / prevention & control
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Anti-HIV Agents* / administration & dosage
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Anti-HIV Agents* / adverse effects
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Anti-HIV Agents* / pharmacokinetics
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Anti-HIV Agents* / therapeutic use
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Antiretroviral Therapy, Highly Active
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Female
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HIV Infections / drug therapy*
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HIV-Associated Lipodystrophy Syndrome / chemically induced
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HIV-Associated Lipodystrophy Syndrome / prevention & control
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Health Resources*
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Humans
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Male
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Peripheral Nervous System Diseases / chemically induced
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Peripheral Nervous System Diseases / prevention & control
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Reverse Transcriptase Inhibitors* / administration & dosage
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Reverse Transcriptase Inhibitors* / adverse effects
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Reverse Transcriptase Inhibitors* / pharmacokinetics
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Reverse Transcriptase Inhibitors* / therapeutic use
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Sex Factors
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Stavudine* / administration & dosage
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Stavudine* / adverse effects
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Stavudine* / pharmacokinetics
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Stavudine* / therapeutic use
Substances
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Anti-HIV Agents
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Reverse Transcriptase Inhibitors
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Stavudine