ABSTRACT
Didanosine (2′,3′-dideoxyinosine, ddI) is a synthetic purine nucleoside analog that is active against HIV-1 and HIV-2, including strains of HIV that are resistant to zidovudine and lamivudine. It was the second drug licensed for the treatment of HIV infection and was initially used as monotherapy, but since 2010 it is no longer recommended by WHO, the European AIDS Clinical Society, and the US Department of Health and Human services (DHHS) for either initial or second-line treatment of HIV infection because of its unfavorable safety profile and the availability of better options. It is no longer used in the USA, Europe, or Australia but continues to have use in low- and middle-income countries, including Russia and Ukraine. Although international guidelines no longer contain didanosine-containing regimens in preferred first- or second-line antiretroviral therapy, there is no guidance for management of patients who remain on didanosine. In 2012 at least 20 countries spent a total of $1 to $2 million on purchasing didanosine (Dziuban et al., 2015).
