{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:33:54Z","timestamp":1790688834386,"version":"4.1.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2012,5,1]],"date-time":"2012-05-01T00:00:00Z","timestamp":1335830400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Antiviral Therapy"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although recent World Health Organization (WHO) guidelines recommend withdrawing stavudine (d4T) from first-line antiretroviral therapy (ART), it remains commonly used in resource-limited settings. In 2006, WHO recommended decreasing the dose of d4T from 40 mg to 30 mg to mitigate toxicities. We compared the incidence and severity of peripheral neuropathy by d4T dose in a retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients\u2019 charts from an ART-naive population at a rural clinic in KwaZulu-Natal, South Africa, were retrospectively reviewed for signs and symptoms of incident peripheral neuropathy and were graded for severity using the DAIDS scale. Patients enrolled prior to the WHO guideline change were included in the study if they were on d4T 40 mg for \u22656 months. After the guideline change all patients were initiated on d4T 30 mg.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 475 patients were analysed, including 235 in the 40 mg cohort (152.7 person-years [py]) and 240 in the 30 mg cohort (244.7 py). Incidence of peripheral neuropathy was 90.4\/100 py (95% CI 75.9, 106.8) in the 40 mg cohort versus 40.5\/100 py (95% CI 32.9, 49.3) in the 30 mg group (incidence rate ratio 0.45; P&lt;0.0001). There was no difference in proportion of severe peripheral neuropathy cases (grade 3\/4) between the cohorts: 8.3% in the 40 mg group and 8.9% in the 30 mg group ( P=1.0). In a multivariate analysis, risk of peripheral neuropathy was associated with increasing age (hazard ratio [HR] 1.65, 95% CI 1.24, 2.19), 40 mg dose (HR 2.1, 95% CI 1.61, 2.74) and concurrent tuberculosis therapy (HR 1.41, 95% CI 1.06, 1.87).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Incidence of peripheral neuropathy in the 40 mg cohort was extremely high and, although lower, the rate in the 30 mg cohort was nonetheless unacceptably high.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3851\/imp2087","type":"journal-article","created":{"date-parts":[[2012,3,13]],"date-time":"2012-03-13T13:19:39Z","timestamp":1331644779000},"page":"737-743","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Effects of a Reduced Dose of Stavudine on the Incidence and Severity of Peripheral Neuropathy in HIV-Infected Adults in South Africa"],"prefix":"10.1177","volume":"17","author":[{"given":"Meera","family":"Pahuja","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA"},{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke","family":"Grobler","sequence":"additional","affiliation":[{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall J","family":"Glesby","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farina","family":"Karim","sequence":"additional","affiliation":[{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Parker","sequence":"additional","affiliation":[{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sizwe","family":"Gumede","sequence":"additional","affiliation":[{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"CAPRISA, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,5,1]]},"reference":[{"key":"bibr1-IMP2087","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60916-8"},{"key":"bibr2-IMP2087","unstructured":"Republic of South Africa. Country progress report on the declaration of commitment on HIV\/AIDS: 2010 report. pp 15. (Updated 31 March 2010. Accessed 10 May 2010.) Available from http:\/\/data.unaids.org\/pub\/Report\/2010\/southafrica_2010_country_progress_report_en.pdf."},{"key":"bibr3-IMP2087","unstructured":"National Department of Health, South Africa. National HIV and syphilis prevalence survey South Africa 2010. (Accessed 13 February 2012.) Available from www.doh.gov.za\/docs\/reports\/2011\/hiv_aids_survey.pdf."},{"key":"bibr4-IMP2087","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000279711.54922.f0"},{"key":"bibr5-IMP2087","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2005.01409.x"},{"key":"bibr6-IMP2087","first-page":"153","volume":"9","author":"Simpson D.M.","year":"1995","journal-title":"J Acquir Immune Defic Syndr Hum Retrovirol"},{"key":"bibr7-IMP2087","doi-asserted-by":"publisher","DOI":"10.1310\/ED57-EU48-RK6A-E5U0"},{"key":"bibr8-IMP2087","doi-asserted-by":"publisher","DOI":"10.1086\/529384"},{"key":"bibr9-IMP2087","unstructured":"World Health Organization. Addendum to 2006 WHO guidelines on antiretroviral therapy for HIV infection in adults and adolescents. (Updated 4 May 2007. Accessed 15 June 2010.) Available from http:\/\/www.who.int\/hiv\/art\/ARTadultsaddendum.pdf."},{"key":"bibr10-IMP2087","unstructured":"World Health Organization. Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents. (Updated 30 November 2009. Accessed 13 February 2012.) Available from http:\/\/www.who.int\/hiv\/pub\/arv\/rapid_advice_art.pdf."},{"key":"bibr11-IMP2087","unstructured":"Treatment action campaign. Detailed commentary on updated ART guidelines. (Updated 23 April 2010. Accessed 13 February 2012.) Available from http:\/\/tac.org.za\/community\/node\/2854."},{"key":"bibr12-IMP2087","unstructured":"Division of AIDS table for grading the severity of adult and pediatric adverse events. (Updated 28 December 2004. Accessed 12 May 2010.) Available from http:\/\/www.ucdmc.ucdavis.edu\/clinicaltrials\/documents\/DAIDS_AE_GradingTable_FinalDec2004.pdf."},{"key":"bibr13-IMP2087","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.07.006"},{"key":"bibr14-IMP2087","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/mus.21535","volume":"41","author":"Maritz J.","year":"2010","journal-title":"Muscle Nerve"},{"key":"bibr15-IMP2087","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.18.1590"},{"key":"bibr16-IMP2087","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2009.00754.x"},{"key":"bibr17-IMP2087","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2010.03.001"},{"key":"bibr18-IMP2087","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000188123.15493.43"},{"key":"bibr19-IMP2087","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2009.07.009"}],"container-title":["Antiviral Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3851\/IMP2087","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3851\/IMP2087","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:50:42Z","timestamp":1777380642000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3851\/IMP2087"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,5]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,5]]}},"alternative-id":["10.3851\/IMP2087"],"URL":"https:\/\/doi.org\/10.3851\/imp2087","relation":{},"ISSN":["1359-6535","2040-2058"],"issn-type":[{"value":"1359-6535","type":"print"},{"value":"2040-2058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,5]]}}}