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Jul 31, 2001

I was diagnosed HIV positive in 2-2001 with viral loan of 286,000 and T- cell count of 206. I have been on Sustiva, Epivir, Zerit but with worsening neuropathy and deep bone pain for last two months. Dr. now wants to take me off zerit and put me on AZT. I have horrible memories of AZT. Frustrated confused in Texas. My one and only count since has been VL of 1070 and T-cell of 604. Am I abandoning effective treatment just to have a new set of side effects and compromising my treatment?

Response from Dr. Pavia

Every drug has potential side effects, so switching is never guaranteed to work. If your neuropathy is indeed due to D4T (zerit), then switching is quite likely to make it better. There are other causes of neuropathy to consider, including B12 deficiency, other drugs like INH and AZT itself. The diagnosis is clinical. Nucleoside related distal symmetric neuropathy is usually equal on both sides, worse in the feet than the hands, tingling or burning, and slowly ascends. If yours fits this pattern, then Zerit is a likely candidate.

AZT at current doses (300 mg twice a day) has fewer side effects than the older higher doses, but can cause headache, nausea, fatigue, or muscle pains. It may be worth a try. Abacavir (Ziagen) could also be used instead of AZT.

I am concerned that you have had only one followup test since February. It has been 6 months. Many HIV docs check response 2-6 weeks after starting, at about 3 months after starting and then at least every 6 months. You are due.

Good luck


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