Stavudine: Uses, Side Effects, and What You Need to Know

When treating HIV, Stavudine, a nucleoside reverse transcriptase inhibitor (NRTI) used to block HIV replication. Also known as d4T, it was once a backbone of HIV treatment but is now rarely prescribed in high-income countries due to serious long-term side effects. Stavudine works by tricking the virus into using it as building material, which stops HIV from copying itself. It’s part of a class of drugs called NRTIs, which includes Zidovudine (AZT), the first FDA-approved HIV drug and a common alternative to Stavudine, and Lamivudine, a less toxic NRTI often paired with Stavudine in older regimens.

Stavudine isn’t used much today in the U.S. or Europe because it can cause nerve damage, fat loss in the face and limbs, and liver problems—side effects that show up slowly but stick around. These aren’t rare either. Studies show up to 30% of people on long-term Stavudine develop peripheral neuropathy, which means tingling, burning, or pain in the hands and feet. That’s why WHO and other health groups now recommend replacing it with safer options like tenofovir or abacavir. But in some low-resource settings, Stavudine is still used because it’s cheap and available. If you’re taking it, your doctor should be monitoring your nerve function, liver enzymes, and body fat changes regularly.

It’s also important to know Stavudine doesn’t work alone. It’s always part of a combo, usually with other antiretrovirals like Lamivudine or Efavirenz, a non-NRTI often used with Stavudine in resource-limited regimens. But even in these combos, the risks haven’t gone away. If you’ve been on Stavudine for years and notice unexplained weight loss in your face or arms, numbness in your toes, or persistent fatigue, talk to your provider. Switching to a safer drug can stop or even reverse some of the damage.

There’s no magic fix for the side effects of Stavudine, but catching them early helps. Blood tests, physical exams, and asking the right questions can make a big difference. And while newer drugs have mostly replaced it, knowing about Stavudine matters—because millions still take it, and understanding why it’s risky helps you make smarter choices about your care. Below, you’ll find real-world guides on managing HIV meds safely, spotting hidden side effects, and navigating treatment options when resources are limited.