What is responsible?
Oct 6, 2003
Dear Doctor, I have been diagnosed with HIV in the year 2000. Within a few months, I began my very first cycle of therapy with Trizivir, and for 3 years I have achieved great results having my VL undetectble and T cell count in a range between 600 and 1000. Recently, I developped a strong form of anemia caused by AZT. At the same time my mouth filled with blisters and peeled off, i could not eat anymore and I lost much waight. The doctor changed the terapy from Trizivir to Epivir, Zerit, Ziagen. Between the two treatments, a month passed during which my mouth completely recuperated and healed perfectly. Now, after 6 weeks in the new treatment my anemia is perfectly fine but my mouth is almost where I left it two months ago.......a bit less acute still. My first question is: it is possble that after 3 years I become intollerant to Trizivir? It is possible that neither Ziagen, Zerit or Epivir are the cause of my mouth infection? Are there alternatives to those drugs? if I propose to my doctor a pharmaceutical vacation, how often should I should check my VL and T cell count?
Response from Dr. Conway
The development of anemia and oral lesions are of concern. In most cases, AZT-associated anemia would not develop suddenly after three years. It may be, however, that the AZT is worsening the anemia that would occur as a result of another cause, and that the anemia might get a little better if the AZT were stopped.
There are a number of diseases/conditions that cause both anemia and mouth lesions. The most important thing to me here is to make a specific diagnosis of the oral sores (perhaps by culture or biopsy) and figuring out what kind of anemia you have before doing anything else.
As far as a drug holiday goes, if your lowest ever CD4 count was at least 300-350 (there is some ongoing debate on what the specific number should be here), it is probably OK to consider a drug holiday, as long as you keep track of the CD4 count after you stop. How often? I would say after one month, and then every 2-3 months if nothing is happening.
However, I would repeat that the most important thing right now is to make a specific diagnosis of the mouth sores.
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