zalcitabine, (ddC, Hivid) a Simple FactSheet from the AIDS Treatment Data Network

||||| Hivid is a Nucleoside Reverse Transcriptase Inhibitor:

zalcitabine, trade name Hivid (also known as ddC), is an anti-HIV treatment in a class of drugs called nucleoside analogs. The body breaks down these drugs into chemicals that stop HIV from infecting uninfected cells in the body, but they do not help cells that have already been infected with the virus. As people with HIV lose CD4 cells - one of the immune system's main defenses - they become more likely to get infections and illnesses. New Public Health Service HIV treatment guidelines say that the best way to use Hivid is in combination with other anti-HIV drugs. The guidelines recommend combinations of three or four anti-HIV drugs as first treatment for HIV. The recommended combinations should take one drug or combo from column A and one combo from column B (Drugs are listed in alphabetical, not priority order): Recommendation Column A Column B Strongly Recommended Sustiva Crixivan Viracept Norvir + Crixivan Kaletra Norvir + Fortovase Videx + Epivir Videx + Zerit Epivir + Zerit Videx + Retrovir Epivir + Retrovir Recommended as Alternatives Ziagen Agenerase Rescriptor Viracept + Fortovase Viramune Norvir Fortovase Retrovir + HIVID Not recommended because of insufficient data hydroxyurea in combo with ARVs Norvir + Agenerase Norvir + Viracept Viread Not Recommended and should not be offered Invirase Zerit + Retrovir HIVID + Videx HIVID + Epivir HIVID + Zerit

||||| Dosage:

Adults take 2.25 mg of Hivid per day divided into three doses. It is important to divide up doses and space them out evenly over the day in order to keep high enough levels of Hivid in the blood.

||||| Side effects:

Hivid rarely causes the anemia or suppression of white blood cells that are the major problem with zidovudine. Side effects of Hivid can be skin eruptions, canker sores, general inflammation of the mouth, nausea, pancreatitis and fever. Pancreatitis can appear as a pain in the stomach area that goes through to your back. A serious side effect of Hivid is an inflammation of the nerves called peripheral neuropathy. The symptoms of peripheral neuropathy are burning or numbing in the hands or, most often, in the feet. The symptoms may start slowly. Some people develop only mild symptoms while others have to contend with serious pain that makes walking difficult. After people stop taking Hivid, their peripheral neuropathy will usually go away, but it can take weeks and even months. Also, peripheral neuropathy may continue to get worse for a little while after Hivid treatment is stopped. Antidepressants such as Elavil seem to have effect in treating peripheral neuropathy. Some people also find acupuncture helpful. Local treatment with a salve or tincture can help symptoms that occur in the mouth.

||||| Warnings:

A set of rare but serious side effects of nucleoside analog anti-HIV drugs is called lactic acidosis and severe hepatomegaly with steatosis (an enlarged fatty liver). Women, especially those who are oveweight, are particularly at risk. This set of side effects is probably the result of mitochondrial toxicity. Mitochondria are cell's power organs that supply the energy needed for normal cell growth. Anti-HIV nucleoside analogs impair the function of mitochondria. This can lead to increased acid levels in the blood, and an enlarged fatty liver. The symptoms are severe nausea, shortness of breath and vomiting that does not get better. If you are taking anti-HIV drugs and experience these symptoms, tell your provider immediately.

||||| Drug interactions:

If you are starting radiation therapy, amphotericin B, pyrimethamine, sulfadiazine, Bactrim, ganciclovir, intravenous pentamidine, or acyclovir, you should discontinue Hivid until you are stable on the other drugs. Combining Hivid with didanosine (ddI, Videx), stavudine (d4T, Zerit) or lamivudine (3TC, Epivir) is not recommended, as these drugs do not work well together. Hoffmann-La Roche, who makes zalcitabine (Hivid), has an Assistance Program for people having trouble affording the drug. Call (800) 285-4484 for more information.

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