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Two of the six classes of the United States Food and Drug Administration (FDA) approved drugs for HIV-1 treatment target the reverse transcriptase (RT) protein, an enzyme critical for the replication cycle of HIV-1 [2]. These two classes are nucleoside RT inhibitors (NRTIs) and non-nucleoside RT inhibitors (NNRTIs). While NNRTIs are allosteric inhibitors that alter the chemical catalysis rate limiting step through conformational changes [3,4], NRTIs mimic nucleotides that bind to the active site of RT. Since NRTIs lack the 30 -hydroxyl group necessary for chain elongation, their incorporation results in termination of the viral DNA transcription [5]. NRTIs are essential components of HAART and part of almost all FDA approved combination therapies for the treatment and protection of an infection with HIV. However, some FDA-approved NRTIs are now rarely prescribed (e.g., stavudine (d4T)) or discontinued (e.g., zalcitabine (ddC)) due to their off-target toxicity.

Stavudine (d4T), sold under the brand name Zerit among others, is an antiretroviral drug used to prevent and treat HIV/ AIDS. It is recommended for use with other antiretrovirals. It may be utilized for prevention after a needlestick injury or other potential exposure. However, it is not a first-line treatment. It is given through oral route. Common reactions including cerebral pain, loose bowels, spewing, rash, and fringe nerve problems. Severe incidental effects including high blood lactate, pancreatitis, and a broadened liver. Stavudin is not suggested in pregnancy. Stavudine is in the nucleoside simple reverse transcriptase inhibitor (NRTI) class of medication. Stavudine was first described in 1966 and endorsed for use in the United States in 1994. It is available in a generic form. Stavudine is used in the therapy of HIV-1 disease, but it is not normally suggested as starting cure. Stavudine can also reduce the risk of creating HIV-1 disease subsequent to coming into contact with the infection either either at work (e.g., needle-stick) or through exposure to infected blood or other bodily fluids. It is continuously utilized in combined with other HIV drugs for the better control of the disease and a decrease in HIV complications.

In 2009, WHO recommended that the drug be phased out of first-line antiretroviral therapy programmes [18]. In 2011, the European Medicines Agency (EMA) warned that d4T should be used for as short a time as possible and only when there are no appropriate alternatives [19,20]. According to the EMA estimation, over a million HIV-positive patients in Europe have been exposed to d4T since its approval, although the number of patients being treated with d4T has declined from over 65 000 in 2005–2006 to nearly 9000 in 2009–2010 [19]. However, utilization of d4T in Europe has not been studied in detail, and it is not known whether prescription patterns are in line with the restricted indication of the drug. EuroSIDA represents a unique opportunity for assessing temporal trends in the uptake of d4T across Europe.

Hyperlactatemia (and LAS) is often associated with symptoms of generalized fatigue, nausea, vomiting, sudden weight loss, abdominal pain and distension. Tachypnea and dyspnea are not reliable early signs of LAS and may signal a preterminal state. Similarly, although serum transaminase levels can eventually rise in patients with LAS, they are often normal at presentation.4 An elevated plasma lactate level is diagnostic of hyperlactatemia (mild 2–5 mmol/L, severe > 5 mmol/L),7 and patients with LAS often have an additional anion gap metabolic acidosis.

Stavudine is used in combination with other antiretroviral drugs to slow the progression of the disease and reduce the risk of opportunistic infections (AIDS-related infections). Stavudine does not cure AIDS nor kill the virus. There is a permanent risk of transmitting HIV either through sexual or blood contact. It is therefore essential that precautions always be taken (latex condoms, clean syringes, etc.). Fertile women must use an effective means of birth control.