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


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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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