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[Viewpoint] The ethics of expanding access to cheaper, less effective treatments

In 1994, the US Food and Drug Administration (FDA) approved stavudine as a treatment for HIV/AIDS at 40 mg twice a day. Stavudine quickly became standard care in high-income countries as part of highly active antiretroviral therapy (HAART).1 In 2006, WHO recommended using a lower dose of this drug (30 mg twice a day). Although effective in reducing viral load, stavudine has serious side effects including peripheral neuropathy, lactic acidosis, and lipodystrophy. An alternative drug zidovudine, also has serious side effects such as anaemia, and is more expensive than stavudine.