n Southern African Journal of HIV Medicine - Is stavudine worth saving? : letters

Volume 13, Issue 2
  • ISSN : 1608-9693
  • E-ISSN: 2078-6751



The ultimate goal of HIV therapy in resource-constrained settings must be to keep as many people alive with the best possible quality of life using the resources available. The question debated between Andrieux-Meyer and Venter might therefore be: 'With the resources available, can we keep more people alive with the best possible quality of life using stavudine 20 mg bd or tenofovir 300 mg od as standard first line therapy?' Quality of life is extremely important but unlikely to be the overriding factor if budgetary constraints restrict access to ART and therefore increase mortality. Both groups seem to agree that tenofovir is superior to stavudine for most patients and that the crux of the argument is about cost. Venter describe tenofovir as 'the gold standard' and state that 'these arguments [about the benefits of tenofovir] are likely to be irrelevant when the cost of medication is considered'. Andrieux-Meyer acknowledge that 'the rationale for this [proposed] trial is to lower treatment costs'.

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