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blast cells in peripheral smear
Jul 17, 2009

Hello Dr.Frascino i am a doctor on hiv meds for last 9 years,even though i had megaloblastic anemia previously,now i am concerned about low neutrophils and blast cells.I am on azt,3tc,nevirapine can i take off from meds for some time time or have to change to next drugs,how long can i take drug holiday,from 9 yrs the vl<50 and cd4 never below 500.please advice.

Response from Dr. Frascino


AZT can induce megaloblastic anemia as well as decreases in white blood cells and platelets due to bone marrow suppression. Drug holidays (strategic treatment interruptions) have been intensely studied and are not recommended. I would suggest you change your drug regimen to avoid AZT. One option would be Atripla (tenofovir, emtricitabine and efavirenz). This would be similar to your current two-nukes-and-a-non-nuke regimen (AZT, 3TC, nevirapine). Atripla has the added benefit of being three mediations combined into a single table, which is taken just once per day. Alternatively there are a number of other "preferred regimens" to consider. Talk to your HIV specialist about which of these options would be best for you to consider.

Good luck.

Dr. Bob

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