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Choice of Meds: Avoiding Zerit-Ziagen Stronger?
Feb 28, 2000

Brief Background: My Baseline counts in Sept. '99 were VL: 650,000/CD-4:270. Started first line meds, consisting of Combivir and Sustiva at that time. By Dec. 15th, my counts had improved nicely to VL: 363/CD4:435. However, I was severely Anemic from the AZT and needed a blood transfusion and procrit to rescue my depleted hemoglobin.

So AZT was replaced by Zerit (D4t) and I regained my normal hemo/counts soon afterward. But the "improvement" plateaued and slightly started to reverse.

My Next 2 tests were: (1) VL 513/CD4:436, on Jan.11 and (2)

VL 1,256/CD4:423, on Jan.26.

You had mentioned that with a high viral load baseline of over 250,000 copies (mine was 650K) that a Quad Cocktail had more opportunity for one to get Undetectable, as the chances with a triple were not as successful.

Taking all of THIS into account. My Physician recently added

a 3rd nuke to my Sustiva, that being Ziagen-with the purpose

of hopefully improving my counts from the the January trend.

I have yet to have my March tests to see if this turned around.

I feel we rushed to replace the AZT with Zerit. Even after just a few months I notice pain and numbness in my fingers

and toes. I also play Jazz in a club, and I detest any chance of neuropathy in my fingers and want to drop the

Zerit-NOW. What do you think? Does a 3rd nuke make that much difference? Do you think Ziagen is stronger (than Zerit) and that I can maintain just with Sustiva, Ziagen and 3TC?

Three nukes must have an increased potential for more side effects. What is your opinion on how to adjust the NRIT's-

there is even pain-when I now type. I thank you so much for

all your care and advice.

Signed

Michael (determined to toss the D4T Yet would still like to become Undetectable or at least have decent counts)

Response from Dr. Holodniy

Your doctor was correct in adding something since you had not got down to < 50/ml and was at a plateau. It's hard to flush out the potency issue, because d4T and ziagen have not been studied head to head as monotherapy. But it looks like from historical data of d4T and abacavir monotherapy studies that ziagen appears more potent. I don't think it's unreasonable to stop the d4T and see what the 3 drugs will do for you.

MH



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