2',3'-Dideoxy-2',3'-didehydrothymidine (D4T) is a thymidine nucleoside analog which has potent anti-human immunodeficiency virus activity in vitro. We have studied its metabolism in cells to assist in determining its mechanism of action. D4T is metabolized in cells to the mono-, di-, and triphosphate nucleotides. Our data suggest that the initial conversion to the monophosphate is catalyzed by thymidine kinase. This enzyme has an affinity for D4T 600-fold lower than for thymidine and catalyzes the rate-limiting step in production of the triphosphate. Nevertheless, intracellular concentrations of the triphosphate approximately equal to the reported Ki for human immunodeficiency virus reverse transcriptase are attained with extracellular concentrations of free drug as low as 0.05 microM. The pattern of phosphorylation is different from that of 3'-azido-3'-deoxythymidine (AZT), which has an affinity for thymidine kinase equivalent to that of thymidine and is easily phosphorylated. The rate-limiting step in formation of AZT triphosphate is conversion of mono- to diphosphate, and thus the monophosphate accumulates. On removal of D4T or AZT from the media, both triphosphates have an intracellular half-life of about 200 min, and this rate ultimately controls the rate of elimination of the drugs from cells. The differences in metabolism of D4T and AZT observed in vitro may be responsible for the differences in toxicity seen in vitro and in vivo and support the exploration of the clinical utility of D4T as an anti-human immunodeficiency virus agent.