Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda

Ned Sacktor, N. Nakasujja, Richard Skolasky, K. Robertson, S. Musisi, A. Ronald, E. Katabira, D. B. Clifford

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)165-170
Number of pages6
JournalNeurology
Volume72
Issue number2
DOIs
StatePublished - Jan 13 2009

Fingerprint

Stavudine
Uganda
Nervous System
HIV
Highly Active Antiretroviral Therapy
Therapeutics
Poisons
AIDS Dementia Complex
Generic Drugs
Executive Function
Sex Characteristics
HIV Infections
Communicable Diseases
Color

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda. / Sacktor, Ned; Nakasujja, N.; Skolasky, Richard; Robertson, K.; Musisi, S.; Ronald, A.; Katabira, E.; Clifford, D. B.

In: Neurology, Vol. 72, No. 2, 13.01.2009, p. 165-170.

Research output: Contribution to journalArticle

Sacktor, N, Nakasujja, N, Skolasky, R, Robertson, K, Musisi, S, Ronald, A, Katabira, E & Clifford, DB 2009, 'Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda', Neurology, vol. 72, no. 2, pp. 165-170. https://doi.org/10.1212/01.wnl.0000339042.96109.86
Sacktor, Ned ; Nakasujja, N. ; Skolasky, Richard ; Robertson, K. ; Musisi, S. ; Ronald, A. ; Katabira, E. ; Clifford, D. B. / Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda. In: Neurology. 2009 ; Vol. 72, No. 2. pp. 165-170.
@article{666f25fb54f5498a9bfbd531efa89b9c,
title = "Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda",
abstract = "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.",
author = "Ned Sacktor and N. Nakasujja and Richard Skolasky and K. Robertson and S. Musisi and A. Ronald and E. Katabira and Clifford, {D. B.}",
year = "2009",
month = "1",
day = "13",
doi = "10.1212/01.wnl.0000339042.96109.86",
language = "English (US)",
volume = "72",
pages = "165--170",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda

AU - Sacktor, Ned

AU - Nakasujja, N.

AU - Skolasky, Richard

AU - Robertson, K.

AU - Musisi, S.

AU - Ronald, A.

AU - Katabira, E.

AU - Clifford, D. B.

PY - 2009/1/13

Y1 - 2009/1/13

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=60549083974&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=60549083974&partnerID=8YFLogxK

U2 - 10.1212/01.wnl.0000339042.96109.86

DO - 10.1212/01.wnl.0000339042.96109.86

M3 - Article

C2 - 19139369

AN - SCOPUS:60549083974

VL - 72

SP - 165

EP - 170

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 2

ER -