Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda
Skolasky, R. L.
Clifford, D. B.
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Background: The frequency of HIV dementia in a recent study of HIV individuals at the Infectious Disease Institute in Kampala, Uganda, was 31%. Coformulated generic drugs, which include stavudine, are the most common regimens to treat HIV infection in Uganda and many other parts of Africa. Objective: To evaluate the benefits and risks of stavudine-based highly active antiretroviral therapy (HAART) for HIV-associated cognitive impairment and distal sensory neuropathy. The study compared neuropsychological performance changes in HIV individuals initiating HAART for 6 months and HIV individuals receiving no treatment for 6 months. The risk of antiretroviral toxic neuropathy as a result of the initiation of stavudine-based HAART was also examined. Methods: At baseline, 102 HIV individuals in Uganda received neurologic, neuropsychological, and functional assessments; began HAART; and were followed up for 6 months. Twenty-five HIV individuals received identical clinical assessments and were followed up for 6 months. Results: In HIV individuals, there was improvement in verbal memory, motor and psychomotor speed, executive thinking, and verbal fluency. After adjusting for differences in sex, HIV individuals demonstrated significant improvement in the Color Trails 2 test (p 0.025) compared with HIV individuals. Symptoms of neuropathy developed in 38% of previously asymptomatic HIV patients after initiation of the stavudine-based HAART. Conclusions: After the initiation of highly active antiretroviral therapy (HAART) including stavudine, HIV individuals with cognitive impairment improve significantly as demonstrated by improved performance on a test of executive function. However, peripheral neurotoxicity occurred in 30 patients, presumably because of stavudine-based HAART, suggesting the need for less toxic therapy