Aids researchers and activists are at loggerheads over the planned SA trial of a lower-dose version of the antiretroviral stavudine, which has debilitating side-effects in HIV patients.
The main adverse effect is peripheral neuropathy, which can be corrected by reducing dosage. The symptoms include burning, stiffness, tingling and numbness.
Stavudine is also the most likely of all the ARVs to cause lipodystrophy or unusual redistribution of fat. It is no longer recommended by the World Health Organisation.
The Treatment Action Campaign, Médecins Sans Frontières and the Treatment Action Group are concerned that stavudine is more toxic than tenofovir – which replaced stavudine in the government programme.
Patients’ poor tolerance means they are more likely to not adhere to treatment. MSF’s experience in Lesotho has also shown that the cost of treating the side-effects neutralised the cost-saving.
Those supporting the stavudine trial say tenofovir is unaffordable. The TAC/MSF group said the price had already halved and might come down more by the end of the trial, which could take nine years to complete.
The stavudine research team, led by the Wits Reproductive Health and HIV Institute’s Professor Francois Venter, said the evidence that stavudine had bad side-effects was at the 40mg dose, at half this dose it had been as effective as tenofovir at suppressing HIV . This had not been established, which is why the study is needed.
He said stavudine was used across Africa and it made sense to find how to used it more safely. – Health-e News.