Nucleoside analogue reverse transcriptase inhibitors (NRTI) have been used to treat HIV-infected patients for more than 20 years, and although their range of toxicity is considered mild, some cases of severe and even fatal toxicity have been described mainly attributed to mitochondrial dysfunction. We report a unique case of stavudine induced hepatic steatosis, hyperlactatemia, lipodystrophy, peripheral neuropathy, dyslipidemia and hyperglycemia in a patient along with zidovudine induced anemia.