Treatment Review; Double Issue #26 & #27 November 1997

AZT (zidovudine, Retrovir): Standard dose is 300 mg taken twice a day. This can somtimes be lowered to reduce side effects. Side effects can include nausea, vomiting, anemia, low white blood cells, bone marrow damage, headaches and loss of muscle tissue. Now also available in pill form in combination with 3TC. The combo pill is called Combivir.

ddI (didanosine, Videx): Comes as chewable tablet or powder. Dose is usually 400 mg a day, but can be adjusted based on your weight. Side effects can include nerve damage in the hands and feet (known as peripheral neuropathy), pancreatitis, and diarrhea. ddI is coated in an antacid buffer that can effect the absorption of other drugs such as dapsone and indinavir.

ddC (zalcitabine, HIVID): Dose is 2.25 mg a day, divided into three doses. Side effects can include peripheral neuropathy, pancreatitis, and sores in the mouth.

d4T (stavudine, Zerit): Dose is usually 40 mg taken twice a day, but can be adjusted to as low as 20 mg twice a day based on your weight or if you experience side effects. Side effects can include peripheral neuropathy, stomach upset, pancreatitis and liver damage.

3TC (lamivudine, Epivir): Dose is 150 mg taken twice a day. 3TC has also shown activity against the hepatitis B virus. Side effects can include headache, nausea, low white blood cells, peripheral neuropathy and rare cases of hair loss.

Protease inhibitors

indinavir (Crixivan): Dose is 800 mg every 8 hours on an empty stomach or with non-fat food like dry toast. Side effects can be nausea and kidney stones. Drinking at least eight large glasses of water a day is recommended with this drug.

nelfinavir (Viracept): Dose is 750 mg taken three times a day, preferably with food. Some doctors recommend not waiting more than 12 hours between doses. The main side effect is diarrhea, which can sometimes be controlled with over the counter antidiarrheal medications.

ritonavir (Norvir): Dose is 600 mg taken twice a day with food (fatty if possible). Side effects can be nausea, diarrhea and numbing around the mouth. Also effects the absorption of many other drugs by the body due to its actions in the liver. There is a long list of drugs that can not be taken when taking ritonavir.

saquinavir (Invirase): Current dose is 600 mg three times a day with food. Side effects include stomach upset and gas. Not as well absorbed by the body as other protease inhibitors. A better absorbed version of saquinavir called Fortovase may be approved in later this year.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

nevirapine (Viramune): Dose is 200 mg once a day for two weeks, with 200 mg taken twice a day after that. Possible side effect can be rash, which in some cases can be severe and require stopping the drug.

delavirdine (Rescriptor): Dose is 400 mg taken three times a day. Possible side effect is a rash, which in some cases can be severe. Severe rash may occur less frequently than with nevirapine.

Anti-HIV drugs that are available in pediatric formulations and approved for use in children are AZT (trade name Retrovir), 3TC (Epivir), ddI (Videx) and d4T (Zerit), nelfinavir (Viracept) and ritonavir (Norvir).

The NNRTI drug delavirdine (Rescriptor) can be dissolved in water but has not yet been studied in children. The other available NNRTI drug nevirapine (Viramune) is not yet approved for kids, but there is a special program that can provide the drug for children. You can call (800) 595-5494 for more information on the nevirapine pediatric program.

The US Government has issued draft guidelines on the use of anti-HIV drugs in children. These guidelines are on the Internet at

http://www.healthcg.com/hiv/guidelines/pediatrics or downloaded from

http://www.hivatis.org. If you don't have access to the Internet call the Network and we'll mail you a copy.

A special registry has been set up to collect information on the use of combination anti-HIV drugs in pregnancy, the contact information is: Antiretroviral Pregnancy Registry, PO Box 13398, Research Triangle Park, NC 27709; phone: (919) 483-9437 (can be called collect) or (800) 722-9292, ext. 39437; fax: (919) 315-8981.

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