Introduction: Stavudine is a commonly used drug in paediatric antiretroviral treatment
(ART) regimens. Due to toxicity concerns, however, the drug abacavir has replaced
stavudine in first-line paediatric regimens inmany countries.Wedescribe the frequency of
stavudine toxicity in children receiving ART at a treatment clinic in Soweto, South Africa.
Methods: Data on patient characteristics and outcomes of ART were collected from a
cohort of 2222 HIV-infected children initiating ART between 2004 and 2008 when
stavudine-containing regimenswere routinely recommended. At several time-points after
treatment initiation, we estimate the proportion of children where an attending clinician
discontinued stavudine due to lipodystrophy, pancreatitis, lactic acidosis or peripheral
neuropathy. Factors associated with stavudine-related toxicities were identified.
Results: At ART initiation, most children had advanced disease. The majority initiated an
efavirenz/lamivudine/stavudine regimen (n¼1422), and 76% of children remained on
their initial ART regimen after a median 19.9 months of ART. Replacement of stavudine
due to drug toxicity occurred at a rate of 28.8 per 1000 child years on treatment (95%
confidence interval¼23.6–35.2). Rates of toxicity increased with treatment duration (in
their first year of ART stavudine was replaced in 0.5% of children, but after 3 years
stavudine had been changed to abacavir in 12.6% of children). Toxicity was more
common in older children and in girls. Lipodystrophy accounted for 87 of 96 toxic events.
Conclusion: Stavudine-associated toxicity resulting in single-drug substitution was
uncommon in this cohort, though its frequency increased steadily with ART duration,
especially with lipodystrophy. Where drug options are limited, stavudine remains a
relatively well tolerated and effective option for children.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/14592 |
| Date | 25 April 2014 |
| Creators | Palmer, Megan |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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