Debate

Why it’s time to say goodbye to stavudine ... everywhere

Isabelle Andrieux-Meyer, Polly Clayden, Simon Collins, Nathan Geffen, Eric Goemaere, Mark Harrington, Sharonann Lynch, Tido von Schoen-Angerer, Tracy Swan
Southern African Journal of HIV Medicine | Vol 13, No 1 | a155 | DOI: https://doi.org/10.4102/sajhivmed.v13i1.155 | © 2012 Isabelle Andrieux-Meyer, Polly Clayden, Simon Collins, Nathan Geffen, Eric Goemaere, Mark Harrington, Sharonann Lynch, Tido von Schoen-Angerer, Tracy Swan | This work is licensed under CC Attribution 4.0
Submitted: 15 December 2012 | Published: 13 March 2012

About the author(s)

Isabelle Andrieux-Meyer, Médecins Sans Frontières Access Campaign, South Africa
Polly Clayden, HIV i-Base
Simon Collins, HIV i-Base
Nathan Geffen, Treatment Action Campaign
Eric Goemaere, Médecins Sans Frontières, South Africa
Mark Harrington, Treatment Action Group
Sharonann Lynch, Médecins Sans Frontières Access Campaign
Tido von Schoen-Angerer, Médecins Sans Frontières Access Campaign
Tracy Swan, Treatment Action Group

Abstract

The previous issue of the SAJHIV (December 2011) carried an Opinion piece by Innes, Cotton and Venter regarding the potential value of low-dose of stavudine (20 mg twice a day). They suggested that reduced dosing of stavudine may lead to levels of viral suppression comparable with those achieved with stavudine 30 mg bd but with a lower risk of toxicity and side-effects, and at a fraction of the cost of tenofovir. The Opinion was related to a larger proposal, led by Venter, to conduct a head-to-head trial comparing low-dose stavudine with tenofovir (both in a regimen including lamivudine and efavirenz) on viral suppression and other treatment outcomes over 24 months. There has been considerable debate regarding the advantages and disadvantages of low-dose stavudine, and in turn the value of any such trial. Here the debate continues with a commentary by Isabelle Andrieux-Meyer et al. and a rebuttal by Venter and colleagues.

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