UNDERSTANDING ANTIVIRALS: AZT, DDI, DDC: The Current Generation of Antivirals


UNDERSTANDING ANTIVIRALS: AZT, DDI, DDC: The Current Generation of Antivirals

Being Alive; November 1992
Mark Katz, MD and reported by Jim Stoecker

It is always good to review where we are, as well as where we are going. Those who feel they have read all they need to know about AZT, ddI, ddC can skip down to the section on the next generation of antivirals.

AZT was the first FDA approved antiviral and is still our first line in the fight against HIV. The current standard of care is 500-600 mg of AZT daily for anyone whose T-cells have dropped below 500. AZT is also recommended for any HIV+ person who has thrush, unexplained fevers or neuropathy, no matter what the T-cell level.

Anemia, a lowering of red blood cells, is the most common side effect of AZT. Because of this, the patient should be monitored by regular blood counts (CBCs). If anemia is going to occur, it is likely to show up within the first six months of AZT therapy. During this start-up period, blood counts should be taken every several weeks. If no problem with anemia, blood counts can then be taken at less frequent intervals. It should be noted that the higher your T-cells when beginning AZT, the less likely there will be side effects.

DDI is another reverse transcriptase (RT) inhibitor and was recently approved by the FDA. Unlike AZT, ddI is not considered a first line drug. The official indication for ddI use is AZT failure or intolerance. Failure is seen when T-cells drop or symptoms reappear during AZT therapy.

Recent ACTG studies that compared ddI to AZT indicate that ddI may work better for those already on AZT. Some AIDS care providers see ddI as the superior antiviral. However, we do not yet have definite data.

The two main side effects seen with ddI are peripheral neuropathy and pancreatitis. Lowering the drug dosage to 400 mg daily seems to reduce the risk of painful neuropathy and potentially fatal pancreatitis.

DDC, another nucleoside analog, is approved by the FDA only for use in combination with AZT. Such combination is officially indicated when AZT monotherapy has failed. Studies have shown that ddC is inferior to AZT or ddI as a single drug antiviral. If you can't tolerate either AZT or ddI, however, ddC is certainly worth a try.

The ddC side effects are the same as those for ddI: pancreatitis and peripheral neuropathy. The incidence of these problems is much less frequent than with ddI.


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