Neurotoxic dideoxynucleoside antiretroviral therapy is not associated with progression of painful distal polyneuropathy

Dideoxynucleoside antiretroviral (d-drug) use is limited by peripheral nervous system toxicity. d-drugs are generically made and are cheaper antiretrovirals then branded non-d-drugs. In the context of financial barriers to delivering HIV care in resource-limited settings, cheaper d-drugs may mean the difference between treatment and no treatment. Whether or not d-drug neurotoxicity is cumulative could determine the applicability of d-drug use in resource-limited settings. In a US cohort of HIV-infected patients, the authors evaluated the safety of continued d-drug use by measuring the risk of d-drug to worsen neuropathy signs or symptoms. A total of 252 subjects on d-drugs were compared with 250 subjects on non-d-drug antiretrovirals and followed over a median of 18 months for signs of worsening neuropathy. The authors found continued d-drug use did not produce progressive signs or symptoms of neuropathy as compared with continued non-d-drug use, in agreement with the Delta trial and other recent cohort studies.