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The More CD4s The Greater The Side Effects?
May 13, 2009

Why is it some drugs still come with a black box warning that starting treatment with more then 350cells/ml can increase the chances of adverse side effects?

Response from Dr. Young

Hello and thanks for your post.

You're probably referring to the warning about initiating treatment with nevirapine (Viramune, part of Triomune) in women with CD4s greater than 250 or men with CD4s greater than 400. In this particular (and unusual case), the higher the CD4 count, the greater the likelihood of developing liver toxicity.

For all other HIV medications, the opposite appears to be the case. The lower the CD4 count, the greater the risk of developing drug-related side effects or toxicity (like anemia, pancreatitis, kidney injury, etc).

Hope this helps, BY



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