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
Sunday, August 24, 2008
Day 6
I’m now on day 6 of my anti-retroviral treatment, and I have no big news to tell you. And that’s a good thing. I’ve been on Lamivudine+Zidovudine twice a day, and Nevirapine once a day.
I was wondering why I was given different meds from the other guy who was starting the same time I was. We had compared notes while at the RITM, and realized I got the Nevirapine which was notorious for rashes, while he got the Efaverenz which was known for dreams, nightmares and hallucinations. I was thinking to myself, “I want to dream, too!”, but just left it all up to fate.
It’s the Nevirapine that I was told to be wary of, because of some possible side effects. But so far, on a once a day dosage, nothing. No gagging, no vomiting, no diarrhea, no fever, no flu, no rashes.
One thing I noticed, is that I get hungry more easily since I started on the meds. It was so bad that I couldn’t wait to get home for dinner Friday night. I had to pass by the local Julie’s Bakery and get me a couple of pieces of bread which I chowed down on walking home. So might this make me put on weight? I hope so. This might just be the answer to my long standing problem of being a hardgainer.
At the RITM last Tuesday, the doctor asked me what time would be most convenient for me to take the meds. Once in the morning, once in the evening at a 12-hour interval. Initially I chose 6:30 am and 6:30 pm, imagining I’d take the meds after breakfast in the morning, and before leaving work in the evening. I eventually changed my mind, and decided on a 9:30 habit. So what happens is I take my meds in the morning while at work, and in the evening, just before going to bed.
The 9:30 habit was a good choice, as I noticed I didn’t feel anything unusual even while at work. Saturday night, though, I realized another side effect that Nevirapine may be having on me.
C, U, and I (Yes… surprise, surprise… C & U knew each other and didn’t tell me until recently… talk about connivance…) met up for some late snacks at the local mall yesterday evening, so for the first time since getting on ARVs, I was up past my usual bedtime of 10:00 pm. I just felt soooo sleepy after taking my medications, but not to the point of dizziness, as I was able to make my way home without problems. So in a couple of days, once I start taking the regular dose of Nevirapine, which is twice a day, I’ll have to figure out how to handle the drowsiness while at work.
U especially had been checking up on me regularly, having experienced the side effects of Nevirapine himself. He and C were both on Efaverenz themselves.
So for now, everything is good. I’m still able to work, still able to do chores, and still able to eat anything I want. Still no one can tell just by looking at me that I have HIV, nor that I’m on ARV medication. I still remain most wary about any signs of rashes. I constantly check my inner arms and forearms, where I am most fair and think that early signs of rashes will be most noticeable.
Watch out for my next big step.
Wednesday, August 20, 2008
A Normal Day?
It's been raining most of the day, and classes have been suspended around Manila. It's almost the end of the day, but we still haven't been let off from work.
Work? Yes! I am working today. It's my first day on ARVs and yes, I am still able to work, which is always a good thing.
I slept through my first set last night. No dreams, no nightmares. No fever, no rashes. Woke up my usual time, went through my usual routine, except of course for my new 9:30 habit.
So here I am, almost at the end of another work day. Been checking my arms regularly for signs of rashes, so far, so good. Looks like I'm surviving. I'm still keeping my fingers crossed.
Tuesday, August 19, 2008
My Long Weekend
Yesterday, August 18 was a holiday in the Philippines, a rescheduling of Ninoy Aquino Day. A long weekend for most. But I had a longer weekend than the rest. I took the day off today, not for a vacation, but to pay the RITM another visit.
Today, I was out of the house by 7:30 am. My appointment at the RITM was still in the afternoon, but I had my day all planned out. I first made my way to the Social Hygiene Clinic at the Manila Health Department, primarily to have my fecalysis and quantitative RPR done, but also to pay the dear doctors a visit.
Only Dr. Diana Mendoza was there, attending to a younger group getting tested for something. After she was done, she looked my way and immediately recognized and greeted me. She asked me if I needed anything, guessing my quantitative RPR almost magically. I nodded, and asked if they did stool tests as well. She said yes, and immediately asked Kuya, the utility guy to run to the lab and request that they do my fecalysis, apparently because I had arrived past the deadline for accepting samples. She wrote out my lab referrals, taking those given to me by the RITM. I had gone there knowing that they conducted the tests for less than the usual cost, but surprisingly, Dr. Diana endorsed them and they were given for free! Lucky me!
So down I went to the lab, where they extracted some blood, and literally took the shit outta me. Well I had my stool sample ready, and had been checking constantly on the way there if it was already stinking up my bag. I was glad to leave my crap there. On the way out, Dr. Diana asked me how I was, complimenting that I looked good. I thanked her and headed off, saying I’d call for a follow-up of the results. This will truly always be my first HIV home.
From there, I took the LRT out to EDSA, and the MRT to Magallanes, where I made my way again via bus to the Alabang area. Arriving in Alabang early, I took my lunch first at Jollibee, a local counterpart of McDonald’s, craving from everything from a Champ to a Jolly Spaghetti, but eventually settling for a Palabok and a large order of Fries. Yum. Not being known for slow eating, I was done in about 20 minutes, with still more time to spare before my afternoon appointment, so I checked out the Alabang Starmall while waiting, but found nothing much to see after less than an hour. It was past 12 noon, so I decided to just head for the RITM and hang out there.
Getting to the RITM, I headed for the OPD room, finding only Ate there. She showed me my CD4 results… 328. I then apologized for being too early, and ushered her off to lunch while offering to man her post somewhat. Sitting there alone, I started computing:
2 months ago, CD4 count = 343
Present, CD4 count = 328
Difference = 15
Decrease = 15 / 2 months = 7.5 per month
At that rate, I would reach the critical CD4 level of 200 after… 1 year, 5 months
Am I obsessed with math or what?! I was meaning for that computation to help me decide whether or not to start on ARVs, but thought maybe my logic didn’t apply to this case, so I shoved it all out the window and just cleared my head.
Shortly after, Ate arrived, as well as some other clients. One has been living positive for 15 years, and was doing voluntary counseling for other clients there. One was like me, CD4 above 300, had never been on ARVs, but wished to start. One was just weeks on ARVs and having his side effects checked. Another one was new, first time at the RITM, armed only with his test results for being positive with HIV. We all got talking while waiting for the doctor, and came to a point where we were sharing our experiences with the newbie, who was clearly still unable to accept his condition. I honestly think it helped him a lot being with and talking to others like him, as he really calmed down and opened up by the time the doctor came around.
Being the first one there, I was served first, as the doctor showed me again my CD4 results. She told me all my other tests were clear, and asked me again whether or not I wanted to start on ARVs. Without flinching, I said yes.
So here I am, in bed with my medicines beside me. One tablet is a combination of Lamivudine and Zidovudine, to be taken twice a day at 12 hour intervals. The doctor guaranteed there are no usual side effects. The other tablet however, Nevirapine, is a different story. Usual side effects are rashes, nausea, vomiting, diarrhea, plus nightmares and hallucinations, i think. I’m supposed to take it once a day for the next two weeks, and guard for the side effects. If everything is good, it increases to twice a day, monitoring closely again for another two weeks. I saw one client there who had the rashes from this same tablet, so I know what to look out for. U says he had the same reaction to it as well. Sigh.
Okay it’s exactly 9:30 pm now, and here goes my first dosage… cheers.
Okay, done. And as it goes, once I start this, it will be a lifetime commitment, and I cannot miss a beat. I’m planning to get a watch with an alarm, just to make sure I never ever forget. I want to get one for U, too.
So anyways, I’ll have more details again tomorrow. For now, I want to rest early, so I can adjust to my new… schedule. I’m putting my laptop away, as I usually have it beside me in bed, just to make sure I don’t beat it up in case I have any nightmares and stuff.
I’m hoping I don’t have any adverse reactions to it, or at least it not be too bad. Wish me luck… good night.
