Transition from stavudine to tenofovir and zidovudine for first-line treatment of HIV/AIDS in low and middle income countries

Background: In 2009, the WHO recommended transition from regimens containing stavudine (d4t) due to side effects, in favor of regimens containing zidovudine (ZDV) and tenofovir (TDF). We describe the transition from stavudine to preferred regimens, and other current purchasing trends.

Methods: We analyzed 17,819 adult ARV purchases between 2009 and 2011, as reported to the World Health Organization Global Price Reporting Mechanism, the Global Fund Price Quality Report, and by UNITAID.

Results: Stavudine's total market value declined from $99.85 million in 2009 to $29.7 million in 2011. Purchases of 3-in-1 fixed dose combinations (FDC) containing d4t represented 1.2 million people who could be treated in a year (person-years) in 2009, dropping to 472,000 person-years in 2011. Purchases of TDF 3-in-1 FDCs increased from 41,000 to 145,000 person-years from 2009 to 2011. Zidovudine 3-in-1 FDC purchases increased from 1.18 to 1.74 million person-years between 2009 and 2010, but then dropped in 2011.

The median annual price of the 3-in-1 FDC containing d4t dropped from $77to $62 per year from 2009 to 2011. ZDV median prices were $137 and $113 in 2009 and 2011, respectively. TDF 3-in-1 with emtricitabine exhibited the smallest change, from $250/year in 2009 to $242 in 2011. The new 3-in-1 with TDF and lamivudine held the lowest median price, at $174 in 2011.

Conclusions: Transition from stavudine has been slow, though some countries have exhibited rapid transition. Price remains a critical concern in transition from stavudine to ZDV or TDF regimens.