Effect of Stavudine-Based Antiretroviral Therapy on the Severity of Polyneuropathy in HIV/AIDS Patients: A Preliminary Report From Zaria, Northern Nigeria

BACKGROUND: Stavudine, a nucleoside reverse transcriptase inhibitor, used as first-line antiretroviral drug in many developing countries is said to exacerbate distal symmetrical polyneuropathy in HIV/AIDS patients. OBJECTIVE: To evaluate the severity of distal symmetrical polyneuropathy in HIV/AIDS patients on stavudine-based antiretroviral therapy. METHODS: Two hundred and twenty consecutive HIV-infected antiretroviral-naïve adults who were eligible for antiretroviral therapy were studied. Each patient was evaluated using a questionnaire, which contained bio-data and distal neurologic symptoms/signs adapted from the subjective peripheral neuropathy screen and the Leeds assessment of neuropathic symptoms and signs pain score. Patients were then put on stavudine, lamivudine and nevirapine. For three months, after which each patient was re-evaluated using the same protocol. Patients with other risk factors for distal symmetrical polyneuropathy were excluded from the study. RESULTS: Three months of antiretroviral therapy reduced the mean neuropathic symptoms and signs scores from 0.71 ± 0.76 to 0.26 ± 0.47 (P=0.00) and 0.72 ± 0.57 to 0.58 ± 0.55 (P=0.00) respectively. The number of patients with symptoms and signs also reduced from 97.8% to 24.4% and 65.9% to 55.0% respectively while the mean CD4+ count rose from 194.3 ± 80.4 cells per μL to 416.1±191.2 cells per μL of blood. CONCLUSION: Three months of stavudine-based antiretroviral therapy reduces the severity of distal symmetrical neuropathy in HIV/AIDS patients, but more studies are needed to evaluate the long-term neuropathic effect of stavudine on Africans.