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WBC, AST, ALT and Trizivir

Aug 24, 2003

Hello,

I just received lab reports after 5 months on Trizivir and Sustiva. Doctor says to get get rid of the AZT because of the decreased WBC and liver toxicities. I am also taking Zithromax for an upper respiratory infection that seemed to clear which I understand also contributes to liver toxicities. She wants to change to either Crixivan 400, Zerit 40, Sustiva 600 OR Ziagen 300, Zerit 40, Epivir 150, Sustiva 600. Below are the pre-treatment labs on 04/04/04 and the most recent labs 8/18/03. I really don't want to change becuase I feel really good on this treatment and the dr says i'm undectable (even though when I got copys of my labs it says <400...is this undetectable?) Please give me your most honest and brutal opinions/answers. Many Many Many thanks to you!!

Pre treatment 04/04/03: CD4:216 VL 17,810 CD 4 POS. LYMPH 14.4, ABS. CD 8 Supressor 903, CD8 Pos Lymph 60.2, CD4/CD8 RATIO 0.23, WBC 3.5, RBC 5.32, Hemoglobin 15.9, Hematocrit 46.1, MCV 87, MCH 29.8, MCHC 34.4, RDW 12.0, Platelets 324, Polys 47, Lymphs 42, Monocytes 7, Eos 3, Basos 1, Polys (absolute) 1.6, Lymphs (absolute) 1.5, Monocytes (absolute) 0.2, Eos (absolute) 0.1, Baso (absolute) 0.0, BUN 14, Creatine, Serum 1.1, BUN/Creatine Ratio 12, Sodium Serum 136, Potassium Serum 4.3, Chloride Serum 99, Carbon Dioxide Total 25, Calcium Serum 9.9, Protein Total Serum 8.2, Albumin Serum 4.3, Globulin Total 3.9, A/G Ratio 1.1, Bilirubin Total 1.0, Alkaline Phosphates Serum 57, AST (SGOT) 34, ALT (SGPT) 35, EBV 3

Post-treatment 08/18/03: CD4:291 VL <400 CD 4 POS. LYMPH 24.3, ABS. CD 8 Supressor 612, CD8 Pos Lymph 51.0, CD4/CD8 RATIO 0.47, WBC 2.5, RBC 4.18, Hemoglobin 14.3, Hematocrit 43.3, MCV 104, MCH 34.3, MCHC 33.2, RDW 13.1, Platelets 306, Polys 42, Lymphs 45, Monocytes 9, Eos 3, Basos 1, Polys (absolute) 1.1, Lymphs (absolute) 1.1, Monocytes (absolute) 0.2, Eos (absolute) 0.1, Baso (absolute) 0.0, Glucose Serum 86 BUN 12, Creatine, Serum 0.9, BUN/Creatine Ratio 13, Sodium Serum 138, Potassium Serum 4.2, Chloride Serum 99, Carbon Dioxide Total 27, Calcium Serum 9.6, Protein Total Serum 7.7, Albumin Serum 4.4, Globulin Total 3.3, A/G Ratio 1.3, Bilirubin Total 0.3, Alkaline Phosphates Serum 56, AST (SGOT) 42, ALT (SGPT) 56

Response from Dr. Holodniy

Your WBC decrease probably is a function of the AZT. Since you were already low to begin with, this is not suprising. That decrease, although significant, is not dangerous. You still have lots of cells. The increase in ALT and AST, at this point, is also trivial and I would not be concerned about that either. I would be inclined to go another month and look at the trends again. If the WBC is below 2000, or the ALT is above 90-100, then you need to make an adjustment. If you had to change, I would probably go with option 2, and save the protease inhibitors for later, if and when you have drug failure.



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