To dodge the infamous side effects of the nuke (NRTI) d4T (Zerit), a widely available HIV med, some physicians are recommending that providers worldwide reduce doses of the drug from the standard 40 mg to 30 mg twice daily, or from 30 mg to 20 mg for those weighing 132 pounds or less.
The docs, from New York City’s AIDS-savvy St. Vincent’s Hospital, have issued a paper citing several studies, including their own, showing that the lower dose of Zerit was just as effective and lacked the common side effects of lipoatrophy (facial- and limb-fat loss) and peripheral neuropathy (arm, leg and foot numbness and pain)—all linked to d4T in numerous studies.
For people who are doing OK on d4T, “I’d consider lowering the dose to prevent future side effects,” says Antonio Urbina, MD, of the St. Vincent’s group. Ditto for drug-resistant people for whom d4T is still an option. “Before combo therapy,” Urbina says, “we used to try to find the maximum tolerated dose.” Now that therapy is better at controlling HIV, he says, it’s time to talk about “maximum effective doses.”
In the U.S., HIV med choices are plentiful and people can avoid d4T altogether. But the lower dose may help developing countries, where options are fewer. There, generic d4T is popular as Stavir or in the three-drug combo Triomune. In response to increasing evidence of d4T side effects in southern Africa, says Francois Venter, MD, president of the region’s HIV Clinicians Society, “Many of us favor the lower dose.”
There are versions of Stavir and Triomune with 30 mgs of d4T along with the 40 mg variety, but no 20 mg pill for those with lower body weight. It might be time for manufacturers to drop the dose.