Lower d4T dose maintains virologic suppression and CD4 increases
Graham McKerrow, HIV i-Base
A French prospective pilot cohort study was carried out in two infectious and tropical units to establish whether or not lowering d4T (Stavudine) levels – with a view to limiting long-term toxicities – would compromise antiviral efficacy. 
Cyrille Delpierre and colleagues report in their poster that reduced-dose d4T containing regimens maintained virologic suppression and CD4 increases over a 12 month period. The question remains as to whether this will affect long-term toxicities. D4T is associated with mitochondrial toxicity
The researchers reduced the d4T dose for 66 people. It was cut from 40mg to 30mg bd for 56 people over 60kg, and from 30mg to 20mg for the 10 others. They monitored the CD4 T-cell counts at the start of the full dose treatment, at the time the dose was reduced and 6 and 12 months after that. 19 people (29%) discontinued d4T, 14 because of previous but lasting side effects (11 with lipodystrophy and 3 with neuropathy).
The potential to use reduced doses of d4T in patients who delevop early symptoms of either peripheral neuropathy of lipoatrophy is a particularly important first management choice for patients using WHO-recommmended fixed dose combination (FDCs) regimens. Similar findings have been frequently reported in HTB. [2, 3]
- Delpierre C, Kirstetter M, Cuzin L et al. Lowering stavudine dosages does not compromise anti-viral efficacy in HIV-1 infected patients. 7th ICDTHI,14-18 Nov, 2004, Glasgow. Abstract P55.
- Lowering dose of d4T can maintain efficacy and reduce side effects. HIV Treatment Bulletin Vol7No5. Aug/Sep 2004.
- Lower doses of d4T produce similar efficacy and reduced side effects. HIV Treatment Bulletin Vol4No10. Dec03/Jan04.