New WHO guidelines recommend the phasing-out of the major HIV-drug Stavudine

Last Updated on November 30, 2009 by Joseph Gut – thasso

November 29, 2009  – The World Health Organization (WHO) recently announced new recommendations (guidelines) on HIV-therapies worldwide.

An important part of this announcement concerns Stavudine.  Countries should phase out the use of Stavudine, the most widespread antiretroviral, because of “long-term, irreversible” side-effects in HIV patients including wasting and a nerve disorder, according to the WHO.

Stavudine [Zerit], also known as d4T, or as generic Stavudine in the market place, is a type of medicine called a nucleoside reverse transcriptase inhibitor (NRTI). This class of medicines blocks reverse transcriptase, a protein that HIV needs to make more copies of itself. According to the WHO, Stavudine is widely available in developing countries as a first-line therapy of the HIV-infection, is relatively cheap, and easy to use. But it causes a nerve disorder leading to numbness and burning pain in the hands and feet, and loss of body fat known as lipoatrophy or wasting, conditions that are disabling and disfiguring.

Of over 4 million people globally who take antiretrovirals, about half (50%) are still on a regimen containing Stavudine, down from 80 percent in 2006 when the WHO first said countries should envisage moving away from it because of its long-term effects.

Less toxic alternatives

The WHO recommends 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 [Retrovir], also known as AZT ZDV, or generic Zidovudine in the marketplace, or TDF Tenofovir [Viread], also known as TDF. These are thought to be equally effective alternatives, according to WHO.

In another considerable change to its existing guidelines, the WHO also recommends that people with HIV, including pregnant women, should start taking antiretroviral drugs earlier to live a longer and healthier life. For the first time it advised HIV-positive women and their babies to take the drugs while breastfeeding to prevent mother-to-child transmission of the virus that causes AIDS.

An earlier start to treatment of HIV-infected adults and adolescents with antiretrovirals reduces their viral load much sooner and therefore also lowers the risk of them spreading the virus, according to the WHO. The new recommendations are based on a solid body of evidence indicating that rates of death, morbidity and HIV and tuberculosis transmissions are all reduced by starting treatment earlier.

This approach is thought to prolong and improve the quality of life of enormous numbers of patients, WHO states. Accoring  to the recent annual UN report, an estimated 33.4 million people worldwide, two thirds of them in sub-Saharan Africa, are infected with the AIDS virus.