December 17, 2011
Fact Sheet 475). Stavudine is also known as d4T or didehydro-deoxythymidine.
Stavudine is the most commonly used anti-HIV medication worldwide. However, in 2009, the World Health Organization recommended that it stop being used because of serious side effects (see below).
Stavudine is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.
There are no absolute rules about when to start ART. You and your health care provider should consider your CD4-cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART.
Stavudine can have serious side effects. In 2009, the World Health Organization recommended that it no longer be used for initial treatment of HIV infection. If you take stavudine with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.
Pregnant women face special risks when taking stavudine. See the information below on lactic acidosis and drug reactions.
Fact Sheet 126 for more information on resistance.
Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance."
Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.
An extended release version of this drug was approved in December 2002. However, due to manufacturing problems, it is not available for sale.
There are no food restrictions with stavudine.
Be sure your health care provider knows if you have had liver problems. Your liver will have to be watched carefully if you take stavudine, and your health care provider might decide that you should not use stavudine at all.
Peripheral neuropathy is a form of nerve damage. It usually shows up as tingling, numbness, or a sharp burning sensation in the feet, legs, or hands. The nerve damage is usually temporary and will go away if you stop taking stavudine, or reduce the dose. If you continue to take stavudine after nerve damage shows up, it may become permanent. See Fact Sheet 555 for more information.
Lipodystrophy is a collection of changes in body shape and blood chemistry. See Fact Sheet 553 for more information. Stavudine is strongly linked to the loss of fat in the legs, arms and face.
Lactic acidosis is a buildup of lactic acid in the blood. This is a by-product of abnormal energy production by the cells. It may be caused by damage to the mitochondria. See Fact Sheet 556 for more information on mitochondrial toxicity. Lactic acidosis can cause severe damage to the pancreas and liver. Symptoms of lactic acidosis can include weight loss, abdominal pain, and severe fatigue. The risk of lactic acidosis is higher for women and people who have taken nucleoside analog drugs for a long time or who are obese.
Stavudine's side effects may be worse if taken with ganciclovir or pentamidine.
Pregnant women should not take stavudine and ddI at the same time due to an increased risk of lactic acidosis.