NICE summary of review conclusions
Overall the systematic review showed no critical difference between stavudine and zidovudine as part of first-line therapy for patients with HIV. Other existing literature reports a more significant side-effect profile with stavudine than zidovudine, and thus stavudine is not recommended as first-line treatment. Future studies and recommendations should focus on specific toxicities and tolerability when comparing these drugs.
Patients with HIV should be given zidovudine as a first-line agent rather than stavudine. This is In accordance with WHO guidelines. This will improve the quality of clinical care by using a drug with similar efficacy but a lower side-effect profile.
The Implications for practice section of the Cochrane review stated:
While stavudine and zidovudine appear to be clinically equivalent in the trial literature, there is a large literature about severe metabolic side effects with stavudine, and for this reason WHO has recently recommended against using stavudine for first-line antiretroviral therapy. Its use may evolve to be restricted to patients with severe anaemia who cannot tolerate zidovudine, or in second-line therapy. Clinical and public health judgment will be needed to weigh the risks and benefits of stavidine compared to zidovudine.