Activity and safety of stavudine

Stavudine (2',3'-didehydro-2',3'-dideoxythymidine or d4T) is a thymidine nucleoside analogue that has potent in vitro activity against zidovudine (3'- azido-3'-deoxythymidine or ZDV)-sensitive and -resistant strains of human immunodeficiency virus type 1 (HIV-1). Clinical responses to stavudine therapy have included increases in CD4 cell counts and reduction in levels of circulating HIV-1 p24 antigen, HIV-1 plasma RNA and infectious virus similar to that observed with other licensed nucleoside reverse transcriptase inhibitors. A delay in disease progression rates, improvement in well- being and weight gain have also been reported with stavudine when compared with zidovudine therapy in zidovudine pretreated patients. Stavudine is safe and well tolerated. The only major associated adverse event is peripheral neuropathy which is disease stage- and dose-dependent and easily managed by dose modification or discontinuation. Stavudine has an additive or synergistic effect when used in combination with other antiretroviral agents except for zidovudine. The documented activity and safety of stavudine warrants its use as a component of a therapeutic strategy.