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Need a Change

Feb 9, 1998

Dear Doctors: My wife was dx'd with AIDS 2 years ago (CD4=5,VL=39,000). She has had a very hard time with drug side effects over this period. She has been on her current combo (Viracept/D4T/DDC)for 7 months and it is working well. Her CD4 has gone over 100 for the first time ever(CD4=125), and her VL is <25. However, she has developed very bad neuropathy in her feet and legs. We want to replace the DDC in her combo. She began to fail Seq/AZT/3TC in the past, and can not tolerate Viramune. Would one of the other NNRTIs be her best choice at this point, and what are their side effects? We welcome your advise. Thanks

Response from Dr. Murphy

Dear Questioner,

The d4T/ddC combo is wrecking your poor wife's nerves. Your options include a switch of the ddC and/or d4T to abacavir (available under an expanded access program, Glaxo Wellcome Pharmaceuticals), ddI (300 mg once daily-but this may also cause neuropathy), adefovir (available under an expanded access program, Gilead Pharmaceuticals), or ritonavir. You could also try delavirdine, the other approved NNRTI. It may help boost the nelfinavir levels as well.

Good luck. At least you have some options.


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