Discontinuing drugs

The most straightforward approach is to discontinue drugs that cause or worsen peripheral neuropathy. Dose reduction is also an option, but this may reduce antiviral potency. As it has become clear that the combination of ddI (didanosine, Videx/VidexEC) and d4T (stavudine, Zerit) is associated with a variety of side-effects, it is no longer considered a preferred combination for first-line therapy.

With improvements in antiretroviral treatment, there are now several alternatives that are similarly effective with less toxicity than the d-drugs. Five other nucleoside or nucleotide analogue reverse transcriptase inhibitors (NRTIs/NtRTIs) can be used to construct a NRTI backbone. Some treatment-experienced patients with extensive NRTI resistance may still need to use ddI or d4T, but if possible, they should avoid using both at once. Some experts have proposed ‘NRTI-sparing’ regimens that contain only non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors, but this approach remains experimental.

If neurotoxic drugs are discontinued when symptoms first emerge, neuropathy symptoms often improve dramatically or disappear completely after a several weeks. If the drugs have been used for an extended period, some nerve damage may be irreversible.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.