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Neuropathic Pain
Mar 1, 2012

I am a HIV patient with CD4 count 488(Feb2012) from India. I was started my ART with (Lamivudine+Nevirapine+Stavudine-30 mg) and continued 5 months this combo. After a severe neuropathic pains I switched my combo d4t to AZT since last two months back. Along with this i am taking pregabalin and Dezela twice a day. But still I donot walking comfortably 100 meters long. Pain in feet are very painful.

Present Medications Lamivudine+Nevirapine+Zuduvodine - Twice Daily Pregabalin and Duzella - Twice Daily

Still is there any offending drug to caused pain in my medication? Is my nervous system is still damaging? Am I going to Disable? I am panic. Please help me.

Response from Dr. Henry

The stavudine you were on may have contributed to your symptoms though it is somewhat unusual to develop severe peripheral neuropathy that rapidly particularly in patients with higher CD4 counts. Switching from stavudine to zidovudine can reduce the risk for peripheral neuropathy but the risk may continue to to some degree (some risk can be seen with the lamivudine as well). The pregabalin (Lyrica in US) and Dezela (duloxetine or Cymbalta in US) can minimize the symptoms of peripheral neuropathy for some patients. Other diagnosis and factors can contribute (such as diabetes, vitamin deficiencies) so an evaluation by a neurologist to determine if the diagnosis of peripheral neurpopathy due to HIV or medications is the proper diagnosis. In the US we often would try to use tenofovir or abacavir instead of stavudine or zidovudine-hopefully that medication is becoming more widely available in a generic form. KH

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