Stavudine

Stavudine is a thymidine-analogue nucleoside reverse-transcriptase inhibitor formerly used against HIV. Mitochondrial toxicity and other serious adverse effects have greatly limited its use.

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Nucleoside reverse-transcriptase inhibitor: An antiretroviral drug that mimics a nucleoside and disrupts HIV reverse transcription. Stavudine belongs to this drug class and blocks viral DNA synthesis.
Lactic acidosis: A dangerous accumulation of lactate in the blood that lowers its pH. Stavudine can cause this rare but serious mitochondrial adverse effect.
Nucleoside analogue: A compound structurally resembling a nucleoside that can interfere with nucleic-acid metabolism. Stavudine was developed as a nucleoside analogue capable of disrupting HIV DNA synthesis.
Tenofovir disoproxil fumarate: A nucleotide reverse-transcriptase inhibitor used in combination HIV treatment and prevention. It became a better-tolerated alternative to stavudine in many treatment regimens.
Reverse transcriptase: An enzyme that makes DNA from an RNA template. Stavudine’s active form inhibits this HIV enzyme during viral genome copying.
Lipoatrophy: Loss of subcutaneous fat, often affecting the face, limbs, or buttocks. Prolonged stavudine treatment is strongly associated with this disfiguring toxicity.
Zidovudine: An early thymidine-analogue antiretroviral drug used to treat HIV infection. Like stavudine, zidovudine targets reverse transcriptase, but has a distinct toxicity profile.
Abacavir: A nucleoside reverse-transcriptase inhibitor used in combination treatment for HIV. Abacavir offered an alternative backbone drug without stavudine’s characteristic lipoatrophy risk.
Thymidine: A pyrimidine nucleoside found in DNA, consisting of thymine linked to deoxyribose. Stavudine mimics thymidine and competes in the pathway that builds viral DNA.
Peripheral neuropathy: Damage to peripheral nerves that can cause pain, tingling, numbness, or weakness. This dose-related adverse effect often required stavudine dose reduction or discontinuation.