Opportunistic Infections and Related Diseases 500. Opportunistic Infections A definition of opportunistic infections. Description of the most common opportunistic infections with links to more detailed information. [Revised: September 12, 2006] 501. Candidiasis (Thrush) A description of candidiasis (thrush), including transmission, symptoms, diagnosis and treatment. [Revised: April 26, 2007] 502. Cryptosporidiosis A description of the opportunistic infection cryptosporidiosis, including symptoms, prevention and treatment. [Revised: April 12, 2007] 503. Cryptococcal Meningitis A description of the opportunistic infection cryptococcal meningitis, including symptoms, prevention and treatment. [Revised: April 26, 2007] 504. Cytomegalovirus (CMV) A description of the opportunistic infection cytomegalovirus (CMV), including symptoms, prevention and treatment. [Revised: April 26, 2007] 505. Dementia and Nervous System Problems A description of dementia and central nervous system problems, including symptoms, prevention and treatment. [Revised: October 27, 2006] 506. Hepatitis: Overview A description of the seven types of viral hepatitis, their symptoms and diagnosis. Basic information on treatment. [Revised: July 23, 2007] 507. Hepatitis C A description of hepatitis C, its diagnosis, treatment and prevention. Discussion of co-infection with both HIV and hepatitis C. [Revised: April 26, 2007] 508. Herpes Simplex (Cold Sores and Genital Herpes) A description of herpes simplex virus that causes cold sores or genital herpes, and its interactions with HIV infection. Transmission, treatment and prevention of herpes simplex. [Revised: May 2, 2007] 509. Herpes Zoster (Shingles) A description of shingles (herpes zoster), including transmission, symptoms, diagnosis and treatment. [Revised: September 1, 2006] 510. Human Papillomavirus (HPV) A description of human papillomaviruses (HPV) and the problems they can cause, including genital warts and cervical dysplasia. [Revised: November 9, 2006] 511. Kaposis Sarcoma (KS) A description of the opportunistic infection Kaposi?s Sarcoma (KS), including symptoms, prevention and treatment. [Revised: May 13, 2007] 512. Lymphoma A description of the opportunistic infection Non-Hodgkins Lymphoma (NHL), including symptoms, diagnosis, prevention and treatment. [Revised: July 23, 2007] 513. Molluscum A description of the opportunistic infection molluscum contagiosum, including symptoms, diagnosis, prevention and treatment. [Revised: May 13, 2007] 514. Mycobacterium Avium Complex (MAC) A description of the opportunistic infection Mycobacterium Avium Complex (MAC), including symptoms, diagnosis, prevention and treatment. [Revised: July 23, 2007] 515. Pneumocystis Pneumonia (PCP) A description of the opportunistic infection pneumocystis jiroveci pneumonia (PCP), including symptoms, diagnosis, prevention and treatment. [Revised: April 12, 2007] 516. Progressive Multifocal Leucoencephalopathy (PML) A description of the opportunistic infection progressive multifocal leucoencephalopathy (PML), including symptoms, diagnosis and treatment. [Revised: April 26, 2007] 517. Toxoplasmosis A description of toxoplasmosis, including transmission, symptoms, diagnosis and treatment. [Revised: July 23, 2007] 518. Tuberculosis (TB) A description of tuberculosis (TB), including transmission, symptoms, diagnosis and treatment. [Revised: October 27, 2006] 519. Wasting Syndrome A description of AIDS wasting, including causes and treatments. [Revised: April 12, 2007] Drugs to Treat Opportunistic Infections 530. Azithromycin (Zithromax) A discussion of the antibiotic drug azithromycin (Zithromax) used to fight some AIDS-related opportunistic infections. [Revised: May 13, 2007] 531. Ciprofloxacin (Cipro) A discussion of the antibiotic drug ciprofloxacin (Cipro) used to fight some AIDS-related opportunistic infections. [Revised: April 26, 2007] 532. Clarithromycin (Biaxin) A discussion of the antibiotic drug clarithromycin (Biaxin) used to fight some AIDS-related opportunistic infections. [Revised: May 13, 2007] 533. Dapsone (Avlosulfon) A discussion of the antibiotic drug dapsone (avlosulfon) used to fight some AIDS-related opportunistic infections. [Revised: September 10, 2006] 534. Fluconazole (Diflucan) A discussion of the antifungal drug fluconazole (Diflucan) used to fight some AIDS-related opportunistic infections. [Revised: April 12, 2007] 535. Trimethoprim/Sulfamethoxazole A discussion of the combination of antibiotic drugs trimethoprim and sulfamethoxazole (also called Bactrim, Septra, TMP/SMX, Cotrimoxazole) used to fight some AIDS-related opportunistic infections. [Revised: June 25, 2007] 536. Filgrastim (Neupogen) A description of the drug filgrastim (neupogen) used to treat neutropenia, a shortage of a type of white blood cell. [Revised: June 25, 2007] 537. Pentamidine A discussion of the drug Pentamidine used to fight some AIDS-related opportunistic infections. [Revised: July 23, 2007] 538. Atovaquone (Mepron) A discussion of the drug Atovaquone used to fight some AIDS-related opportunistic infections. [Revised: April 26, 2007]   source:

480. Immune Therapies in Development A description of immune stimulators in development against HIV. [Revised: June 25, 2007] 481. Immune Restoration A discussion of ways to restore the immune function of people with HIV. [Revised: June 25, 2007] 482. Interleukin-2 A description of interleukin-2, an immune stimulator that increases the number of CD4 cells, its dosage and side effects, and its use in treating HIV. [Revised: April 26, 2007] 483. Immune Restoration Syndrome A description of the inflammatory syndrome sometimes experienced by people starting antiviral treatment. [Revised: April 26, 2007] 494. Recreational Drugs and HIV A discussion of the interactions between recreational drug use and the risk of becoming infected with HIV, or having a bad drug interaction. [Revised: May 14, 2007]   source: The AIDS Infonet

Background 400. HIV Life Cycle A diagram of the steps in the HIV life cycle. [Revised: April 27, 2007] 401. Taking Current Antiretroviral Drugs (2 pages) A chart showing currently approved antiretroviral drugs and standard dosages. There are notes on how to take and store each drug, and on the most common side effects. [Revised: June 25, 2007] 402. Drug Names and Manufacturers A chart showing the various names of HIV antiretroviral drugs, including their manufacturer and year of FDA approval. [Revised: July 18, 2007] 403. What Is Antiretroviral Therapy (ART)? An overview of antiretroviral drug therapy (ART) to treat HIV. [Revised: June 25, 2007] 404. 2006 Antiretroviral Therapy Guidelines A discussion of official US guidelines for treatment of HIV. [Revised: October 10, 2006] 405. Adherence Adherence means taking all your pills every day, on time. This fact sheet discusses why this is so important, and gives some advice on how to make it easier to do. [Revised: July 18, 2007] 406. Treatment Interruptions Many people with HIV would like to stop taking their medications, at least for a while. This might help some people, but it can have some serious risks. [Revised: October 10, 2006] 407. Drug Interactions Some drugs affect how quickly other drugs are removed from the body. This can cause an overdose or drug levels that are too low to be effective. Food and herbal products can also change drug levels. [Revised: April 26, 2007] 408. Salvage Therapy A description of “salvage therapy” for people with HIV who have used up most of their antiretroviral treatment options [Revised: August 17, 2007] Nukes: Nucleoside Analog Reverse Transcriptase Inhibitors 410. Nucleoside Analog Reverse Transcriptase Inhibitors in Development A description of new reverse transcriptase inhibitors in human studies to fight HIV. [Revised: August 15, 2007] 411. Zidovudine (Retrovir, AZT) A description of the antiretroviral drug zidovudine (Retrovir®, AZT) including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 17, 2006] 412. Zalcitabine ((Hivid, ddC) A description of the antiretroviral drug ddC (Hivid®) which was discontinued from manufacture and sale in February 2006. [Revised: October 17, 2006] 413. Didanosine (Videx, ddI) A description of the antiretroviral drug ddI (Videx®) including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 16, 2006] 414. Stavudine (Zerit, d4T) A description of the antiretroviral drug d4T (Zerit®) including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 16, 2006] 415. Lamivudine (Epivir) A description of the antiretroviral drug 3TC (Epivir®) including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 16, 2006] 416. Abacavir (Ziagen) A description of the antiretroviral drug Abacavir (Ziagen®) including dosing, side effects, and a general discussion of who should take this drug. [Revised: August 17, 2007] 417. Combivir (zidovudine + lamivudine) A description of the antiretroviral medication Combivir®, a combination of zidovudine and lamivudine, including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 23, 2006] 418. Trizivir (zidovudine + lamivudine + abacavir) A description of the antiretroviral medication Trizivir®, a combination of zidovudine, lamivudine, and abacavir, including dosing, side effects, and a general discussion of who should take this medication. [Revised: July 23, 2007] 419. Tenofovir (Viread) A description of the antiretroviral drug tenofovir (Viread®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: July 23, 2007] 420. Emtricitabine (Emtriva) A description of the antiretroviral drug (ARV) emtricitabine (Emtriva®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: April 26, 2007] 421. Truvada (Tenofovir + Emtricitabine) A description of the antiretroviral medication Truvada, a combination of tenofovir and emtricitabine, including dosing, side effects, and a general discussion of who should take this drug. [Revised: April 26, 2007] 422. Epzicom (Kivexa, abacavir + lamivudine) A description of the antiretroviral medication Epzicom, a combination of abacavir and 3TC, including dosing, side effects, and a general discussion of who should take this drug. [Revised: October 16, 2006] Non-Nukes or NNRTIs: Non-Nucleoside Reverse Transcriptase Inhibitors 430. Non-Nucleoside Reverse Transcriptase Inhibitors in Development A description of non-nucleoside reverse transcriptase inhibitors in development against HIV. [Revised: September 12, 2006] 431. Nevirapine (Viramune) A description of the antiretroviral drug nevirapine (Viramune®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: August 16, 2007] 432. Efavirenz (Sustiva) A description of the antiretroviral drug efavirenz (Sustiva®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: February 14, 2007] 433. Delavirdine (Rescriptor) A description of the antiretroviral drug delavirdine (Rescriptor®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: May 13, 2007] 439. Atripla (efavirenz + emtricitabine + tenofovir) A description of the three-in-one combination antiretroviral drug (ARV) Atripla®, including dosing, side effects, and a general discussion of who should take this drug. [Revised: July 23, 2007] Protease Inhibitors 440. Protease Inhibitors in Development A description of protease inhibitors in development against HIV. [Revised: December 18, 2006] 441. Indinavir (Crixivan) A description of the antiretroviral drug indinavir (Crixivan®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: May 13, 2007] 442. Ritonavir (Norvir) A description of the antiretroviral drug ritonavir (Norvir®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: May 13, 2007] 443. Saquinavir (Invirase) A description of the antiretroviral drug indinavir (Invirase®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: September 10, 2006] 444. Nelfinavir (Viracept) A description of the antiretroviral drug nelfinavir (Viracept®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: May 13, 2007] 445. Amprenavir (Agenerase) A description of the antiretroviral drug Amprenavir (Agenerase®), including dosing, side effects, and a general discussion of who should take this drug. [Revised: May 13, 2007] 446. Lopinavir + ritonavir (Kaletra)

200. Important Resources in the USA A listing of AIDS organizations in New Mexico and the US with a link to a national database. [Revised: October 10, 2006] 201. How Do I Start? When you first learn that you are HIV-positive, you need to learn more about HIV, monitor your immune system, and decide how you want to deal with HIV. [Revised: February 14, 2007] 202. Choosing an HIV Care Provider It is important to find an HIV care provider who works with HIV/AIDS patients and stays up to date. Your relationship with your care provider will be better if you are comfortable with each other and your manner of dealing with health issues. [Revised: July 18, 2007] 203. Medical Appointments Tips on how to get the most from your health care office visits. [Revised: April 26, 2007] 204. Telling Others You are HIV Positive It can be difficult to know who to tell that you are HIV-positive, and when to tell them. There are some general guidelines, and some special situations. [Revised: April 12, 2007] 205. Participating in a Clinical Trial You can participate in scientific studies (clinical trials) of new drugs. There are benefits and risks to consider. Laws protect participants, and they can drop out of a clinical trial at any time. [Revised: August 24, 2007] 206. How to Spot HIV/AIDS Fraud There is no cure for HIV. Some treatments have not been tested and might be harmful. If it sounds too good to be true, it might be a fraud. Check out any product or treatment carefully; look for warning signs of fraud. [Revised: August 24, 2007] 207. Vaccinations and HIV A discussion of the risks and benefits of various vaccinations for people with HIV. [Revised: April 26, 2007] 208. Selling Your Life Insurance How you can get benefits from your life insurance policy while you are still alive. [Revised: November 21, 2006]

150. Stopping the Spread of HIV How HIV infection is transmitted and how you can protect yourself and others from HIV infection. [Revised: May 13, 2007] 151. Safer Sex Guidelines How to reduce the risk of HIV infection during sexual activity. [Revised: July 18, 2007] 152. How Risky Is It? A discussion of the risk of transmitting HIV through various types of sexual activity. Factors that increase the risk of transmission. [Revised: June 25, 2007] 153. Condoms Discussion of the use of condoms for HIV prevention, including the female condom and the spermicide nonoxynol-9. Condom myths and realities. [Revised: April 12, 2007] 154. Drug Use and HIV Drug use and transmission of HIV through unsafe sex and shared equipment. Drug interactions and needle exchange. [Revised: May 14, 2007] 155. Harm Reduction and HIV Harm reduction focuses on improving individual and public health more than on elimination of harmful behaviors. Harm reduction can be applied to reducing HIV-related risks of drug use or of unsafe sexual activity. [Revised: September 5, 2006] 156. Treatment After Exposure to HIV Post-exposure prophylaxis (PEP) is treatment after exposure to HIV. It is intended to prevent HIV infection. PEP is available for workplace exposure to HIV and is being studied for non-occupational exposures. [Revised: August 24, 2007] 157. Microbicides A discussion of efforts to develop a woman-controlled HIV prevention tool using microbicides. [Revised: June 29, 2007] 158. AIDS Myths and Misunderstandings A discussion of myths, misunderstandings, and realities regarding AIDS transmission, effects, and medications. [Revised: April 26, 2007]   source: The AIDS Infonet

120. Normal Laboratory Values A listing of normal values for commonly used laboratory tests. [Revised: April 26, 2007] 121. Complete Blood Count (CBC) A description of the laboratory tests included in a complete blood count (CBC). [Revised: May 13, 2007] 122. Chemistry Panel A description of the laboratory tests normally included in a chemistry panel, plus electrolytes and kidney and liver function tests. [Revised: April 12, 2007] 123. Blood Sugar and Fats A description of the laboratory tests for blood levels of fats (triglycerides and cholesterol) and sugar (glucose). [Revised: June 25, 2007] 124. CD4 (T-cell) Tests A description of CD4 cell tests, how they are done, and what the results mean. Which diseases appear at various CD4 cell levels. [Revised: February 20, 2007] 125. Viral Load Tests A description of viral load tests, how they are done, and what the results mean. [Revised: September 5, 2006] 126. HIV Resistance Testing A description of genotypic and phenotypic tests for viral resistance, how they are used, and what the results mean. [Revised: May 12, 2007] 127. Monitoring Drug Levels Therapeutic drug monitoring means testing blood to measure how much of a drug is present. Unusual drug levels might explain high levels of side effects, or treatment failure. [Revised: April 12, 2007] 128. Body Composition Tests A description of the types of body composition tests, how and why they are used, and what results mean. [Revised: June 25, 2007] source: The AIDS Infonet

WHAT IS ABACAVIR? WHO SHOULD TAKE ABACAVIR? WHAT ABOUT DRUG RESISTANCE? HOW IS ABACAVIR TAKEN? WHAT ARE THE SIDE EFFECTS? HYPERSENSITIVITY REACTION HOW DOES ABACAVIR REACT WITH OTHER DRUGS? WHAT IS ABACAVIR? Abacavir (Ziagen®), is a drug used as part of antiretroviral therapy (ART). It is manufactured by GlaxoSmithKline. Abacavir used to be called 1592U89. The FDA approved abacavir late in 1998. In 2006 a generic version manufactured by Aurobindo was tentatively approved. Abacavir is a type of drug called a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes. WHO SHOULD TAKE ABACAVIR? Abacavir was approved as an antiretroviral drug (ARV) for people with HIV infection. It has been studied in adults and children 3 months old and older. There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking HIV medications. Fact Sheet 404 has more information about guidelines for the use of ART. If you take abacavir with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer. Abacavir seems to get into the central nervous system (spinal fluid). Therefore, it may help prevent mental problems such as dementia. See Fact Sheet 505 for more information on dementia. WHAT ABOUT DRUG RESISTANCE? Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance. Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance". Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses. Abacavir appears to work even when HIV has some resistance to other reverse transcriptase inhibitors. HOW IS ABACAVIR TAKEN? Abacavir is taken by mouth as a capsule. The normal adult dose is 300 milligrams (mg) two times a day. The capsules are 300mg, so you will take 1 capsule at a time. Children take a liquid form. The amount of liquid depends on the child’s body weight. Abacavir can be taken with food, or between meals. Abacavir is also available in Trizivir and Epzicom. Trizivir contains AZT, 3TC, and abacavir. Epzicom contains 3TC and abacavir. See Fact Sheet 418 for more information on Trizivir. See Fact Sheet 422 for more information on Epzicom. WHAT ARE THE SIDE EFFECTS? When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time. The most common side effects of abacavir are headache, nausea and vomiting. HYPERSENSITIVITY REACTION About 8% of people who take abacavir have an allergic reaction. This usually develops within two weeks of starting abacavir. However, it can appear up to six weeks or more after starting. Patients had the following symptoms: Fever (80% of patients) Rash (60-70%) Headache/feeling bad/no energy (60%) Nausea, vomiting, diarrhea, or stomach pain (50%) Cough, shortness of breath, or sore throat (20%) If you have a hypersensitivity reaction, the symptoms will get worse each time you take a dose and will not go away until you stop taking the drug. If you develop any of these symptoms while taking abacavir, call your health care provider immediately. If you have an allergic reaction to abacavir, do not ever start taking it again. A few allergic patients who re-started abacavir had life-threatening reactions. If you ever stopped abacavir for any reason (for example, because you ran out), talk to your health care provider before you start again. In rare cases, people who thought they weren’t allergic had serious reactions when re-starting abacavir. HOW DOES ABACAVIR REACT WITH OTHER DRUGS? Abacavir can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking. However, no specific interactions with other ARVs have been identified yet. The triple combination of abacavir plus AZT (Retrovir) plus 3TC (Epivir) should only be used if no stronger regimen is available. The combination of Abacavir + tenofovir (Viread) + 3TC (Epivir) should not be used without additional ARVs. source: The AIDS Infonet

WHAT IS LAMIVUDINE? WHO SHOULD TAKE LAMIVUDINE? WHAT ABOUT DRUG RESISTANCE? HOW IS LAMIVUDINE TAKEN? WHAT ARE THE SIDE EFFECTS? HOW DOES LAMIVUDINE REACT WITH OTHER DRUGS? WHAT IS LAMIVUDINE? Lamivudine (Epivir®), is a drug used as part of antiretroviral therapy (ART). It is manufactured by GlaxoSmithKline. Generic versions made by Ranbaxy and Aurobindo Pharma were approved in 2005 for sale outside the US. Lamivudine is also known as 3TC. Lamivudine is a nucleoside analog reverse transcriptase inhibitor, or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes. WHO SHOULD TAKE LAMIVUDINE? Lamivudine was approved as an antiretroviral drug (ARV) for people with HIV infection. It has been studied in adults and children over 3 months old. There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART. If you take lamivudine with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer. A different formulation of lamivudine has been approved for people with hepatitis B. Some people with HIV had their hepatitis B get worse after they stopped taking lamivudine. Get tested for hepatitis B before you start taking lamivudine to treat HIV. If you have hepatitis B and stop taking lamivudine, your health care provider should carefully monitor your liver function for several months. WHAT ABOUT DRUG RESISTANCE? Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance. Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance." Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses. Lamivudine seems to be able to reduce resistance to AZT. That is, after people develop resistance to AZT and then take lamivudine, AZT seems to work better for them. HOW IS LAMIVUDINE TAKEN? Lamivudine is available in tablets of 150 and 300 milligrams (mg). It is also available in liquid form, manufactured both by GlaxoSmithKline and by Aurobindo Pharma. The normal dose of lamivudine is 300 mg daily: either one 300 mg tablet daily, or one 150 mg tablet twice a day. The dosage should be reduced for people who weigh less than 50 kilograms (110 pounds). Lamivudine can be taken with food or between meals. Be sure your health care provider knows if you have had kidney problems: your dose of lamivudine may need to be lowered. Lamivudine is also available in Combivir, Trizivir and Epzicom. Combivir contains AZT and lamivudine. Trizivir contains AZT, lamivudine, and abacavir. Epzicom includes abacavir and lamivudine. For more information, see Fact Sheet 417 on Combivir, Fact Sheet 418 on Trizivir or Fact Sheet 422 on Epzicom. WHAT ARE THE SIDE EFFECTS? When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time. The most common side effects of lamivudine are nausea, vomiting, fatigue, and headaches. Some people have trouble sleeping. There have been rare cases of hair loss. HOW DOES LAMIVUDINE REACT WITH OTHER DRUGS? Lamivudine can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking. Lamivudine should not be taken with emtricitabine (Emtriva, FTC) because these drugs are very similar and there is no additional benefit. Blood levels of lamivudine may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs. Lamivudine + abacavir (Ziagen) + tenofovir (Viread) or lamivudine + ddI (Videx) + tenofovir (Viread): These combinations are linked to a high rate of treatment failure and should not be used without other ARVs. source: The AIDS Infonet

WHAT IS STAVUDINE? WHO SHOULD TAKE STAVUDINE? WHAT ABOUT DRUG RESISTANCE? HOW IS STAVUDINE TAKEN? WHAT ARE THE SIDE EFFECTS? HOW DOES STAVUDINE REACT WITH OTHER DRUGS? WHAT IS STAVUDINE? Stavudine (Zerit®) is a drug used as part of antiretroviral therapy (ART). It is manufactured by Bristol-Myers Squibb. In July 2005, the FDA approved a generic version, and in December 2005 a liquid version, both made by Aurobindo Pharma for sale outside the US. Stavudine is also known as d4T or didehydro-deoxythymidine. Stavudine is a nucleoside analog reverse transcriptase inhibitor,or nuke. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes. WHO SHOULD TAKE STAVUDINE? Stavudine was approved in 1994 as an antiretroviral drug (ARV) for people with HIV infection from newborns through adults. There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART. If you take stavudine with other ARVs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer. Pregnant women face special risks when taking stavudine. See the information below on lactic acidosis and drug reactions. WHAT ABOUT DRUG RESISTANCE? Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance. Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance." Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses. HOW IS STAVUDINE TAKEN? Stavudine is available in capsules of 15mg, 20mg, 30mg, and 40mg. The normal adult dose depends on body weight. If you weigh more than 60 kilograms (132 pounds), the dose is 40 mg twice daily. If you weigh less, the dose is 30 mg twice daily. A liquid version is available outside the US for newborns through adolescents. An extended release version of this drug was approved in December 2002. However, due to manufacturing problems, it is not available for sale. There are no food restrictions with stavudine. Be sure your health care provider knows if you have had liver problems. Your liver will have to be watched carefully if you take stavudine, and your health care provider might decide that you should not use stavudine at all. WHAT ARE THE SIDE EFFECTS? When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time. The most serious side effects of stavudine are peripheral neuropathy, lipodystrophy and lactic acidosis. Peripheral neuropathy is a form of nerve damage. It usually shows up as tingling, numbness, or a sharp burning sensation in the feet, legs, or hands. The nerve damage is usually temporary and will go away if you stop taking stavudine, or reduce the dose. If you continue to take stavudine after nerve damage shows up, it may become permanent. See Fact Sheet 555 for more information. Lipodystrophy is a collection of changes in body shape and blood chemistry. See Fact Sheet 553 for more information. Several studies found that stavudine is strongly linked to the loss of fat in the legs, arms and face. Many drugs seem to contribute to lipodystrophy and we don’t fully understand how it occurs. However, some people are avoiding stavudine because of its link to lipodystrophy. Lactic acidosis is a buildup of lactic acid in the blood. This is a by-product of abnormal energy production by the cells. It may be caused by damage to the mitochondria. See Fact Sheet 556 for more information on mitochondrial toxicity. Lactic acidosis can cause severe damage to the pancreas and liver. Symptoms of lactic acidosis can include weight loss, abdominal pain, and severe fatigue. The risk of lactic acidosis is higher for women and people who have taken nucleoside analog drugs for a long time or who are obese. HOW DOES STAVUDINE REACT WITH OTHER DRUGS? Stavudine can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking. Stavudine should not be taken with AZT (zidovudine, Retrovir®) or didanosine (ddI, Videx®). Stavudine’s side effects may be worse if taken with ganciclovir or pentamidine. Pregnant women should not take stavudine and didanosine at the same time due to an increased risk of lactic acidosis. source: The AIDS Infonet

WHAT IS COMBIVIR? WHO SHOULD TAKE COMBIVIR? WHAT ABOUT DRUG RESISTANCE? HOW IS COMBIVIR TAKEN? WHAT ARE THE SIDE EFFECTS? HOW DOES COMBIVIR REACT WITH OTHER DRUGS? WHAT IS COMBIVIR? Combivir is a pill that contains two drugs used as part of antiretroviral therapy (ART): zidovudine (Retrovir, AZT) and lamivudine (Epivir, 3TC). Combivir is manufactured by GlaxoSmithKline. A generic version manufactured by Ranbaxy was approved in 2005 for sale outside the US. The drugs in Combivir are called nucleoside analog reverse transcriptase inhibitors, or nukes. These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes. WHO SHOULD TAKE COMBIVIR? Combivir was approved in 1997 as an antiretroviral drug (ARV) for people with HIV infection. Combivir should not be used by children younger than 12 years old because the individual doses of zidovudine and lamivudine cannot be adjusted. Some people with HIV had their hepatitis B get worse after they stopped taking lamivudine, a part of Combivir. Get tested for hepatitis B before you start taking Combivir to treat HIV. If you have hepatitis B and stop taking Combivir, your health care provider should carefully monitor your liver function for several months. See Fact Sheet 506 for an overview on hepatitis. There are no absolute rules about when to start ART. You and your health care provider should consider your CD4 cell count, your viral load, any symptoms you are having, and your attitude about taking ART. Fact Sheet 404 has more information about guidelines for the use of ART. If you take Combivir with other ARV drugs, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer. Children under 12 years old and people with kidney problems should not take Combivir. Combivir provides two drugs in one pill. It can be more convenient to use Combivir than some other combinations of drugs. This could mean fewer missed doses and better control of HIV. WHAT ABOUT DRUG RESISTANCE? Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance. Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance." Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses. HOW IS COMBIVIR TAKEN? Combivir is taken by mouth as a tablet. The normal adult dose is one tablet, two times a day. Each tablet includes 300 milligrams (mg) of zidovudine (Retrovir) and 150 mg of lamivudine (Epivir). Combivir can be taken with food, or between meals. The dosage of lamivudine should be reduced for people who weigh less than 50 kilograms (110 pounds). People who weigh less than 110 pounds should normally not take Combivir. WHAT ARE THE SIDE EFFECTS? When you start any ART, you may have temporary side effects such as headaches, high blood pressure, or a general sense of feeling ill. These side effects usually get better or disappear over time. The most common side effects of Combivir are the same as with zidovudine (Retrovir) and lamivudine (Epivir). They include headache, upset stomach, and fatigue. See Fact Sheet 551 for more information on fatigue. The most serious side effects of zidovudine are anemia, granulocytopenia, and myopathy. Very few people have these side effects. If they occur, your health care provider will probably have you stop using Combivir. See Fact Sheet 411 on zidovudine for more information on these side effects. Anemia is a shortage of red blood cells caused by damage to bone marrow. Fact Sheet 552 has more information on anemia. Granulocytopenia is a shortage of white blood cells caused by damage to bone marrow. Myopathy is muscle pain and weakness. There is no specific treatment for myopathy. HOW DOES COMBIVIR REACT WITH OTHER DRUGS? Combivir can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking. Combivir should not be taken with with stavudine (Zerit®, d4T). Also, lamivudine and emtricitabine (FTC) are very similar and should not be taken together. Blood levels of lamivudine may be increased by bactrim or septra. See Fact Sheet 535 for more information on these drugs. Zidovudine’s side effects may be worse if you are taking several other drugs. Methadone may increase blood levels of zidovudine. If you take combivir and methadone, watch for zidovudine side effects. source: The AIDS Infonet