IUPAC name 1-4-azido-5-hydroxymethyl tetrahydrofuran-2-yl-5-methylpyrimidine-2,4-dione. Formula C10H13N5O4. Zidovudine or azidothymidine (AZT), also called ZDV is a nucleoside analog reverse transcriptase inhibitor (NRTI), a type of antiretroviral drug. It was the first approved for treatment of HIV. It is also sold under the names Retrovir and Retrovis, and as an ingredient in Combivir, Epzicom and Trizivir.
Zidovudine was the first drug approved for the treatment of AIDS and HIV infection. Jerome Horwitz of Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine first synthesized AZT in 1964, under a US National Institutes of Health (NIH) grant. AZT was originally intended to treat cancer, but was shelved after it proved ineffective in treating cancer in mice.
In February 1985, Samuel Broder, Hiroaki Mitsuya, and Robert Yarchoan, three scientists in the National Cancer Institute (NCI), collaborating with Janet Rideout and several other scientists at Burroughs Wellcome (now GlaxoSmithKline), started working on it as an AIDS drug. After showing that this drug was an effective agent against HIV in vitro, the NCI team conducted the initial phase 1 clinical trial that provided evidence that it could increase CD4 counts in AIDS patients.
Modern treatment regimens typically use lower dosages (e.g. 300 mg) two times a day. As of 1996, AZT, like other antiretroviral drugs, is almost always used as part of highly active antiretroviral therapy (HAART). That is, it is combined with other drugs in order to prevent mutation of HIV into an AZT-resistant form.
Common side effects of AZT include nausea, headache, changes in body fat, and discoloration of fingernails and toenails. More severe side effects include anemia and bone marrow suppression, which can be overcome using erythropoietin or darbepoetin treatments. These unwanted side effects might be caused by the sensitivity of the alpha-DNA polymerase in the cell mitochondria. AZT has been shown to work additively or synergistically with many anti-HIV agents; however, acyclovir and ribavirin decrease the antiviral effect of AZT. Drugs that inhibit hepatic glucuronidation, such as indomethacin, acetylsalicylic acid (Aspirin) and trimethoprim, decrease the elimination rate and increase the toxicity.
AZT does not destroy the HIV infection, but only delays the progression of the disease and the replication of virus, even at very high doses. During prolonged AZT treatment HIV has the ability to gain an increased resistance to AZT by mutation of the reverse transcriptase. A study showed that AZT could not impede the resumption of virus production, and eventually cells treated with AZT produced viruses as much as the untreated cells. So as to slow the development of resistance, it is generally recommended that AZT be given in combination with another reverse transcriptase inhibitor and an antiretroviral from another group, such as a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor.
I had been on my first month on the Lamivudine+Zidovudine combination, so I had been scheduled by the doctor yesterday for a complete blood count. I took the afternoon off from work, and trekked to the RITM, getting there at exactly 2:00 pm. I was sent straight to the lab to have my blood extracted, so the results would be available the same time the doctor was ready to meet me. I never realized it took as little as less than 30 minutes to complete a CBC lab test. Technology rocks.
After hanging out a couple of hours with the other clients there, even having an afternoon snack with the regular counselor, the results were finally realeased and the doctor had finished all the other clients before me. I was a bit surprised by the verdict, another change in medication. The doctor and Ate discussed a bit and agreed they were to make the change. Apparently, my Hemoglobin count had dropped from 140+ units to 100+ units, a side effect of Zidovudine. Ate even pointed out that my lips were a bit pale, something I never noticed myself. The doctor looked under my lower eyelid, and said it still wasn't too noticeable. But yes, they'd shift me over to another medication.
I hadn't brought what was left of my Lamu+Zido meds, so I promised I'd bring it on my next visit. I was given in place of it, solo Lamivudine tablets, plus the new one, Tenofovir, under the brand name Viread. It all seemed like a great move, as the doctor pointed out I'd just have to drink all three of my medications once a day in the evening. One tablet of Efavirenz, two tiny tablets of Lamivudine, and one teardrop-shaped tablet of Tenofovir. Not too bad. When I asked if I'd need to watch out for any side effects, the doctor said there are none. Even better.
So last night, I started my new nightly habit. The doctor advised me to comeback after about three months for another CBC, just to make sure my Hemoglobin has bounced back, but no other problems should be encountered. Hopefully, things will be all good.
Goodbye, Zidovudine.
Wednesday, September 24, 2008
Bye to Zido
Monday, September 22, 2008
In My Head
What’s been running through my head lately? Efavirenz. And I’m not exaggerating. This is my third week on Efavirenz, and it’s been trying to drive me crazy.
When the doctor changed my medication from Nevirapine to Efavirenz at the RITM two weeks ago, she had warned me about the side effects. Among these, were dizziness and dreams. I was thinking anything would be better than the fever and rashes I was experiencing with Nevirapine.
So I started on Efavirenz, just once a day, taking the doctor’s advice to take it in the evening, making sure I’d have nothing important to do after taking it. I never experienced any of the dreaming, but man, she wasn’t kidding about the dizziness.
I’ve been trying to come up with some way to accurately describe the feeling, and I’ve actually come up with a number of them.
First thing that came to mind, was that it felt like I was seeing the world through someone else’s prescription lenses. It was like being drunk, but not tipsy. My mind was all a blur.
It wasn’t exactly impairing me. Rather it was even making me move faster. More efficient maybe? I’ve noticed I’ve been able to go through my morning routine faster, making me arrive at work earlier. I even walk faster. I don’t know if it’s giving me more energy or something, but the world seemed to slow down relatively. Crazy, huh?
A friend of mine may have caught a good description, saying it must feel like being on a third straight cup of coffee. I couldn’t really tell, not being a coffee drinker, but maybe, it made some sense.
I also described it as feeling like everything I do, everything I hear, everything I think, everything I see, just echoes in my head twenty times before setting in. It felt chaotic.
So that’s how I’ve been feeling for the past two weeks. Admittedly, I seem to be getting the hang of it. At this point, it’s no longer as bad as the first few days. Things in my head are clearer now, and I feel I’m getting back to my old self again. U and C did say it’d be this way, and that I should be dizziness-free anywhere between a week and a month.
So all in all, I’m pretty happy about the Efavirenz. I haven’t been having to think about it much, and have even had to worry more about my Hepatitis B and Syphilis. Well, not really.
I’ve visited the doctors at Social Hygiene Clinic again to start another round of penicillin shots for my Syphilis. As for the Hepa, the lab tests show I’m an active carrier, and the result of the latest lab test for the Hepa Viral Load hasn’t come out yet. The doctor says it’s nothing to worry about, because one of my HIV medications, Lamivudine, is actually also a medication for Hepatitis B. So we’re actually hitting two birds with one stone here.
The fortunate thing is that I haven’t had any manifestations of either of what a doctor friend of mine regards as my HIV “add-ons”. I’ve always said, having HIV is one thing, but adding Hepatitis B and Syphilis isn’t anything to be proud of. Although, it’s still far from the end of the world.
So for now, they’re just a few things more to deal with, aside from work, family and love. Just another part of the macro scale of life. No biggie.
How about you? What’s been running through your head lately?
Tuesday, September 09, 2008
Oh Efa, My Efa
Efavirenz. We’d actually met long before it became part of my own regimen.
The first time U and I met, we watched a movie together. The movie time just happened to encompass the time he was supposed to take his medicines. He had accidentally dropped his Efavirenz inside the theater, and he couldn’t figure out where it went. We waited for the end of the movie when all the other people in our row had stood and left. With our cellphones as lights, we started searching under the seats for his tablet. I asked him what it looked like, having no idea. He said it was a small, yellow tablet. I picked up something small and yellow. Good thing I didn’t shout that I’d found it, because I realized all I had in my hand was an unpopped kernel of corn which just may have come from heaven knows whose mouth. Recalling that incident still makes me giggle, with a bit of embarrassment as well.
So how was my first night through Efavirenz? I can’t really say. It’s a pretty cloudy picture. Here’s the deal, I took my first tablet last night at 9:30, along with the Lamivudine+Zidovudine. I was lights out by 10:00 pm. I left a small night light on in the room, just in case I wake up suddenly wondering where I am.
All I can recall is a whole lot of tossing and turning. I even remember telling myself I’d have to kill someone for keeping me up that late. The last time I checked the time it was past 1:00 am. At some point, I was lying in a plate of food, trying to split it into four portions... with my body. And of all things, it was adobo... chicken adobo. I do not have any particular addiction to chicken adobo. I found it a bit weird that I could recall it that vividly.
I’m not sure for which parts of the night I was actually awake or not, but I never ever recalled losing sight of my night light. So it’s either I had carried it over into my dream, or I hadn’t slept a wink. I honestly cannot figure it out. If only based on the headache I have right now and the bags under my eyes, I don’t think I slept a minute. Everything is just so fuzzy.
Hopefully, with the wear of still recovering from the Nevirapine, plus the possibility of two whole days without rest behind me by tonight, I’ll surely be seeing the sandman.
Monday, September 08, 2008
Dream, Dream, Dream
I haven’t really been able to blog lately, not by any choice of my own, I was just literally physically unable to blog.
I had taken the trip out to the RITM mid-week last week. Half of my purpose was to introduce my new friend to the RITM, as he’d be starting his own journey very soon. The other half of my purpose was to update them on how I was doing with my meds.
I had started my double dose September 2nd, and was experiencing low-grade fevers the two days following. Sadly we didn’t catch the doctor, since she had a personal emergency she had needed to take care of. Instead Ate contacted her via mobile, and it was agreed that I’d try to continue the medication, and if anything else comes up or gets worse, I’d just inform them and they’d decide whether I was to stop or not.
And indeed, worse was it. Friday caught me down with the weather at work, where I was struggling to get through even the final few hours at work. I had a fever, which felt worse than my usual. I didn’t have my thermometer with me, so I had no way of telling. I had even gone up to the lobby of an upper floor to rest my eyes. I was feeling that bad.
Getting home, I locked myself in my room, and my trusty thermometer read a 39-degree fever. Still I wouldn’t give up and continued taking my medicines that evening.
Saturday morning came, and I still had the fever, this time it was up to 40 degrees. I realized that my thermometer could only read up to 42 degrees, so I was pretty alarmed. I didn’t even mind that it was just 7 in the morning, I sent a text message to Ate, to which she immediately replied for me to stop the Nevirapine and report to the RITM come Monday.
You’d think my problems were over, but the fever was hell. I felt half-dead and half-dying. Having no airconditioning, no fan, layered with a sweater and a blanket did nothing. The chills were coming from deep inside. I felt I needed to swallow a blanket or kill whatever vents were inside me. I just felt helpless.
I was locked in my room most of the weekend, tossing and turning in discomfort, sneaking in an occasional cold shower to disperse the fever I was experiencing. Monday, I called in to work sick, and just headed to the RITM in the afternoon. I still had a significant fever, and my body just felt so heavy. Each step felt ten times more of an effort to make. I figure I must’ve been walking like I had a hangover.
The verdict? The doctor concluded I was showing allergic reactions to the Nevirapine. Though I didn’t really see signs of being counted as the 103rd Dalmatian, the doctor did notice I was reddish around the face, something which I do not normally get, as I can only be dark or darker. I was just lucky enough I guess that it was an even color, something less noticeable that the kinds of rashes I’ve seen.
I ended up surrendering what Nevirapine I had left, which was one unopened bottle and about half of another, trading it in for my new best friend, Efavirenz. Yes, yes, the dreaming drug. One huge difference is that it’s only taken once a day. Some things I was told to watch out for are dizziness and the dreams, of course. Some people describe the dreams as very realistic, in full-color, plus they say the dreams are usually resumed in cases where you wake up in the middle of one. The doctor also warned me that in standard drug tests, Efavirenz causes false positives for Marijuana, which is never a good thing. So if ever the need arises, it should be advised to the laboratory prior, so they can proceed to a confirmatory test, for which it should turn out negative. Good thing I’m not due to get my license renewed for another three years.
As I’m writing this, I’m feeling a bit better. Less of a headache, and lower fever. I’m hoping this is a good sign, so I can report back to work tomorrow. For now, I’m almost due for my first dose of my new regimen. And boy, am I ready to dream!
