MEDICAL UPDATE: D4T - A New RT Inhibitor

MEDICAL UPDATE: D4T - A New RT Inhibitor

Being Alive Newsletter, Being Alive/Los Angeles - October 1992
Mark Katz MD and reported by Jim Stoecker

D4T is currently being developed by Bristol-Myers, the manufacturers of ddI. This drug works at the same point in the HIV life cycle as AZT, ddI and ddC, and is, like these other antivirals, classified as a reverse transcriptase (RT) inhibitor. D4T, however, does show some promise of being superior in efficacy to the current crop of RT inhibitors.

With AZT, ddI and ddC, we usually see a rise in T-cell count during the first 4-6 months of therapy and then a return to baseline. Of course, the benefit of antiviral therapy is seen not only in T-cell counts. We also need to consider the general survival benefit where disease progression is slowed. Nonetheless, we would all like to see a more sustained rise in CD4.

The exciting news about D4T is that the drug does appear to be able to sustain elevated T-cell counts. Researchers reported in Amsterdam on a study of about 200 people on 0.1 to 12 mg of D4T a day. In general, there was evidence of increased T-cells, weight gain, and overall improvement of symptoms. And for those patients with a greater than 50% rise in CD4, there was a median duration of improvement of over one year. In other words, T-cell counts stayed above baseline a good deal longer than the 4-6 months seen with currently available antivirals.

D4T appears to be well tolerated at lower doses. At the higher doses, peripheral neuropathy appears to be a problem. Researchers are concerned that there may be a small window of benefit for D4T. Is the dosage where the drug's benefits are seen too high to avoid side effects? This question needs to be answered by further studies.

In Los Angeles, a study of D4T is underway at USC, Harbor UCLA and Cedars-Sinai. Researchers are looking for participants with CD4 between 50 and 500 who have been on AZT at least six months and have not taken ddI or ddC. If interested and qualified, you can call 213.343.8281 (USC, ask for Sergio Codina), 310.533.3848 (Harbor UCLA, ask for Rick Johnson), or 310.855.3896 (Cedars).

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