Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda

Neurology. 2009 Jan 13;72(2):165-70. doi: 10.1212/01.wnl.0000339042.96109.86.

Abstract

Background: The frequency of HIV dementia in a recent study of HIV+ individuals at the Infectious Disease Institute in Kampala, Uganda, was 31%. Coformulated generic drugs, which include stavudine, are the most common regimens to treat HIV infection in Uganda and many other parts of Africa.

Objective: To evaluate the benefits and risks of stavudine-based highly active antiretroviral therapy (HAART) for HIV-associated cognitive impairment and distal sensory neuropathy. The study compared neuropsychological performance changes in HIV+ individuals initiating HAART for 6 months and HIV- individuals receiving no treatment for 6 months. The risk of antiretroviral toxic neuropathy as a result of the initiation of stavudine-based HAART was also examined.

Methods: At baseline, 102 HIV+ individuals in Uganda received neurologic, neuropsychological, and functional assessments; began HAART; and were followed up for 6 months. Twenty-five HIV- individuals received identical clinical assessments and were followed up for 6 months.

Results: In HIV+ individuals, there was improvement in verbal memory, motor and psychomotor speed, executive thinking, and verbal fluency. After adjusting for differences in sex, HIV+ individuals demonstrated significant improvement in the Color Trails 2 test (p = 0.025) compared with HIV- individuals. Symptoms of neuropathy developed in 38% of previously asymptomatic HIV+ patients after initiation of the stavudine-based HAART.

Conclusions: After the initiation of highly active antiretroviral therapy (HAART) including stavudine, HIV+ individuals with cognitive impairment improve significantly as demonstrated by improved performance on a test of executive function. However, peripheral neurotoxicity occurred in 30 patients, presumably because of stavudine-based HAART, suggesting the need for less toxic therapy.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS Dementia Complex / drug therapy*
  • AIDS Dementia Complex / physiopathology
  • Acquired Immunodeficiency Syndrome / complications*
  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / adverse effects
  • Antiretroviral Therapy, Highly Active / adverse effects
  • Antiretroviral Therapy, Highly Active / methods
  • Cognition Disorders / chemically induced
  • Cognition Disorders / drug therapy*
  • Cognition Disorders / physiopathology
  • Cognition Disorders / virology
  • Developing Countries
  • Disability Evaluation
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Outcome Assessment, Health Care
  • Risk Assessment
  • Stavudine / administration & dosage*
  • Stavudine / adverse effects
  • Treatment Outcome
  • Uganda

Substances

  • Anti-HIV Agents
  • Stavudine