New WHO Guidelines Urge Phase-Out of Major HIV Drug

New HIV/AIDS treatment guidelines announced on Monday by the World Health Organization (WHO) include phasing out the use of stavudine (d4T) due to its side effects.

Stavudine has long-term, cumulative and irreversible side effects such as peripheral neuropathy (nerve disorder characterized by numbness, weakness and burning pain of hands and feet), and lipoatrophy (loss of fat from specific parts of the body). While its use has declined globally from about 80 percent of people taking ARVs in 2006, about half of patients still are using a d4T-containing regimen, WHO said.

Marketed by Bristol-Myers Squibb Co. as Zerit in the United States, d4T is manufactured in generic forms by Indian firms Cipla Ltd., Aurobindo Pharma Ltd., and Strides Arcolab Ltd. Because it is relatively cheap and easy to use, d4T is a widely prescribed first-line AIDS drug in low- and medium-income countries.

WHO's new guidelines propose that countries "progressively phase out the use of stavudine as a preferred first-line therapy option and move to less toxic alternatives such as zidovudine (AZT) and tenofovir (TDF)," which are comparable in terms of efficacy. However, while safer than d4T, AZT and TDF are currently more expensive first-line therapies, WHO acknowledged.

WHO called on countries using d4T to draw up plans to move toward AZT- or TDF-based first-line regimens, based on the assessment of cost and feasibility. WHO also said it would assist countries in creating phase-out plans that would not jeopardize treatment access or sustainability.

"[D4T] is the most widely used," said Dr. Siobhan Crowley of WHO's HIV/AIDS department. "There is a trend moving away from it. We think it will take some time."

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