Effectiveness and safety of 30 mg versus 40 mg stavudine regimens: a cohort study among HIVinfected adults initiating HAART in South Africa

Maskew, Mhairi; Westreich, Daniel; Fox, Matthew P.; Maotoe, Thapelo; Sanne, Ian M.
January 2012
Journal of the International AIDS Society;2012, Vol. 15 Issue 1, p1
Academic Journal
Background: As stavudine remains an important and widely prescribed drug in resource-limited settings, the effect of a reduced dose of stavudine (from 40 mg to 30 mg) on outcomes of highly active antiretroviral therapy (HAART) remains an important public health question. Methods: We analyzed prospectively collected data from the Themba Lethu Clinic in Johannesburg, South Africa. We assessed the relationship between stavudine dose and six-and/or 12-month outcomes of stavudine substitution, failure to suppress viral load to below 400 copies/ml, development of peripheral neuropathy, lipoatrophy and hyperlactatemia/lactic acidosis. Since individuals with a baseline weight of less than 60 kg were expected to have received the same dose of stavudine throughout the study period, analysis was restricted to individuals who weighed 60 kg or more at baseline. Data were analyzed using logistic regression. Results: Between 1 April 2004 and 30 September 2009, 3910 patients were initiated on antiretroviral therapy (ART) with a recorded stavudine dose and were included in the analysis. Of these, 2445 (62.5%) received a 40 mg stavudine dose while 1565 (37.5%) received 30 mg. In multivariate analysis, patients receiving a 40 mg dose were more likely to discontinue stavudine use (adjusted odds ratio, OR 1.71; 95% confidence limits, CI 1.13-2.57) than those receiving 30 mg by 12 months on ART. Additionally, patients receiving 40 mg doses of stavudine were more likely to report peripheral neuropathy (OR 3.12; 95% CI 1.86-5.25), lipoatrophy (OR 11.8; 95% CI 3.2-43.8) and hyperlactatemia/lactic acidosis (OR 8.37; 95% CI 3.83-18.29) in the same time period. Failure to suppress HIV viral load within 12 months of HAART initiation was somewhat more common among those given 40 mg doses (OR 1.62; 95% CI 0.88, 2.97) although this result lacked precision. Sensitivity analyses accounting for death and loss to follow up generally supported these estimates. Conclusions: Lower stavudine dosage is associated with fewer reports of several stavudine-associated adverse events and also a lower risk of stavudine discontinuation within the first year on ART.


Related Articles

  • Spectrum of Adverse Events After Generic HAART in Southern Indian HIV-Infected Patients. Kumarasamy, N.; Venkatesh, Kartik K.; Cecelia, Anitha J.; Devaleenal, Bella; Lai, Andrew R.; Saghayam, Suneeta; Balakrishnan, P.; Yepthomi, Toku; Poongulali, S.; Flanigan, Timothy P.; Solomon, Suniti; Mayer, Kenneth H. // AIDS Patient Care & STDs;Apr2008, Vol. 22 Issue 4, p337 

    To determine the incidence of clinically significant adverse events after long-term, fixed-dose, generic highly active antiretroviral therapy (HAART) use among HIV-infected individuals in South India, we examined the experiences of 3154 HIV-infected individuals who received a minimum of 3 months...

  • A longitudinal study of stavudine-associated toxicities in a large cohort of South African HIV infected subjects.  // BMC Infectious Diseases;2011, Vol. 11 Issue 1, p244 

    The article presents information on a study conducted on the effects of stavudine-related toxicities in HIV-infected persons undergoing highly active anti-retroviral therapy (HAART) in South Africa. In the study, the proportion of HAART-related side effects for stavudine were compared to...

  • Emtricitabine/tenofovir-disoproxilfumarate.  // Reactions Weekly;9/8/2012, Issue 1418, p23 

    The article describes the case of a 49-year-old woman with HIV-1 infection who developed Fanconi syndrome-like tubular acidosis after receiving highly active antiretroviral treatment (HAART) containing emtricitabine/tenofovir disoproxil fumarate.

  • NEW HIV RECOMMENDATIONS TO IMPROVE HEALTH, REDUCE INFECTIONS AND SAVE LIVES.  // Central European Journal of Public Health;2010, Vol. 18 Issue 2, p115 

    The article reports on HIV recommendations that will be released by the World Health Organization (WHO) in 2010. The recommendations will include the use of antiretroviral drugs (ARVs) for the reduction of HIV transmission between mother and child, the type of ARVs that will be delivered, and...

  • Perinatal HIV and Option B+. Theron, Gerhard // South African Journal of Obstetrics & Gynaecology;Oct2012, Vol. 18 Issue 3, p66 

    An introduction is presented in which the editor discusses various reports within the issue on topics including the minimal access to antiretroviral therapy (ART), meta-analysis and systematic review of efavirenz (EFV) safety, and in vitro exposure of infants to antiretrovirals (ARVs).

  • partial suppressor:. Huber, Jeffrey T.; Gillaspy, Mary L. // Encyclopedic Dictionary of AIDS-Related Terminology;2000, p172 

    A definition of the term "partial suppressor," which refers to an individual taking highly active antiretroviral therapy whose viral load sometimes rises above the undetectable level, is presented.

  • Antiretrovirals.  // Reactions Weekly;12/15/2012, Issue 1432, p9 

    The article describes the clinical cases of six patients who developed lactic acidosis while under highly active antiretroviral therapy (HAART) with nucleoside reverse transcriptase inhibitors treatment regimen.

  • Four-Year Treatment Outcomes of Adult Patients Enrolled in Mozambique's Rapidly Expanding Antiretroviral Therapy Program. Auld, Andrew F.; Mbofana, Francisco; Shiraishi, Ray W.; Sanchez, Mauro; Alfredo, Charity; Nelson, Lisa J.; Ellerbrock, Tedd // PLoS ONE;2011, Vol. 6 Issue 4, p1 

    Background: In Mozambique during 2004-2007 numbers of adult patients ($15 years old) enrolled on antiretroviral therapy (ART) increased about 16-fold, from ,5,000 to 79,500. All ART patients were eligible for co-trimoxazole. ART program outcomes, and determinants of outcomes, have not yet been...

  • The Macroeconomic Consequences of Renouncing to Universal Access to Antiretroviral Treatment for HIV in Africa: A Micro-Simulation Model. Ventelou, Bruno; Arrighi, Yves; Greener, Robert; Lamontagne, Erik; Carrieri, Patrizia; Moatti, Jean-Paul // PLoS ONE;Apr2012, Vol. 7 Issue 4, p1 

    Aim: Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics