Usage of stavudine (D4T) – a retrospective analysis in a South London hospital

Abstract

British HIV Association (BHIVA) guidelines are updated on a regular basis with emergence of new clinical evidence. In June 2003, the BHIVA guidelines recommended that stavudine (D4T)-containing regimens are less preferred if other viable options are available. A retrospective analysis was conducted to establish whether local prescribing practice reflects national guidance offered by BHIVA. This study identifies 28 patients on D4Tcombinations, which represents 2% of the total treated group in our clinic population. In all, 89% (25/28) of patients had a viral load of <50 copies/mL and CD4 counts ranged from 122 to 1016 cells/mm³. In this study, 12/28 patients had documented lipodystrophy. Seventeen out of 28 patients had no clear documented reasons for remaining on D4T, eight patients preferred to continue and three patients continued because of genotypic findings. This study shows that a small proportion of patients are still on D4T-containing regimen for the following reason –patient's choice, side-effects, toxicities and interaction. The majority of patients remaining on D4T had documented lipodystrophy changes. Therefore, clinicians continuing to prescribe D4T should document the precise reason for its continued use. If patients prefer to continue D4T, this should be well documented to circumvent any medicolegal consequences, should toxicity develop later.