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Can Videx be Toxic?
Dec 20, 2004

I was diagnosed with HIV 2 years ago. I went on drugs a couple of weeks after catching the virus testing negative for the virus but have a viraload of 20k. I was very briefly on Kaletra but once the doctor received the mutation labs, he took me off the Kaletra. The three drugs I take are virramune, videx, viread. I was undetectable within 2 months of becoming positive but my tcells went from 700 to 1100 down to 700 then 500 and dropped below 300. The sharp decline began in Sept 2003 almost a year after becoming positive. My doctor was perplexed to see my tcells climb and then gradually drop over the last year. I have taken the regime religiously resulting in an undetectable viralload. He had heard that decreasing one part of my regimen (videx) to 200mg might help because in rare cases it can inhibit the bone marrow from being productive. Have you heard of such a thing in regards to videx? I take great care of myself and have had no HIV related illness or symptoms. The most recent test since decreasing the videx dosage to 200 mg showed my tcells going up to 398. I am hopeful but this is still a fraction of what my previous tcell count yielded and wonder if the drugs are toxic to my body. Any insight into my situation would be greatly appreciated.

Response from Dr. Pierone

Yes, several recent studies have suggested that Videx may lower CD4 cells. The combination of Viread and Videx has a drug interaction that leads to higher levels of Videx and this seems to account for the heightened toxicity that has been observed. In the most recent presentation, when the dose of Videx was reduced there were signs of CD4 count improvement (as in your case).

There are less toxic alternatives than Videx that should be considered for routine use. For example, Epivir and Emtiva are often paired with Viread to form the nucleoside backbone and don't lower CD4 cells. These agents should be used before Videx to form the nucleoside backbone in most cases. They are better studied and lead to fewer adverse effects. Sometimes resistance mutations force our hand. For example, the M184V mutation confers resistance to Epivir and Emtiva and would lead to the use of a second line agent like Videx.



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