Hi,

My doctor recently started me on zerit, viread and sustiva. I'm doing fine so far, but I've been hearing a lot of bad stuff about zerit lately.

Do you still recommend zerit to your patients? What are some of the side effects I should look out for?

thanks for the advice! Jim

Yes, I still recommend Zerit (stavudine) to my patients, but as options grow I'm doing it less frequently. The problems associated with Zerit (mainly lactic acidosis and lipoatrophy) are common to all nucleoside analogues to some extent, although they do appear to occur somewhat more frequently in patients on Zerit than other nucleoside analogues. Still, Zerit has been shown in many studies to have few side effects when it is initially started (which causes problems in a lot of patients who stop their medications early on due to tolerance issues), is not associated with anemia (as is Retrovir [zidovudine]) or a hypersensitivity reaction (as is Ziagen [abacavir]), and has been shown to be highly effective in combination with other antiretrovirals, especially Epivir (lamivudine) with either Sustiva (efavirenz) or Kaletra (lopinavir/ritonavir). Due to the risk of potential toxicity, I advise patients of the risks and we watch carefully for any problems. Also, I do not use it with Videx (didanosine) since that may cause an increased risk of toxicity. If my patient develops signs or symptoms of hyperlactatemia (lactic acidosis is rare occurrig in <1% of patients) or early lipoatrophy (in the latest study, Gilead 903, the risk of clinician/patient diagnosed lipoatrophy at 96 weeks of a Zerit-containing regimen was 12%), we change therapies. Studies show that if these are appropriately managed the risk of severe problems is low and lipoatrophy may reverse somewhat if caught early and therapy is changed. Finally, the other major toxicity of Zerit is peripheral neuropathy (numbness/tingling generally in the feet) which occurs in <10% of patients and should also be watched for.