Stavudine Nelfinavir

STAVUDINE NELFINAVIR Possibly t adverse effects Uncertain Warn patient that diarrhoea may occur... 

Nelfinavir is a nonpeptidic, rationally designed HIV protease inhibitor. Nelfinavir has demonstrated efficacy in both monotherapy and in combination with the reverse transcriptase inhibitors stavudine (d4T) or zivudine + 3TC. The major side effect is mild to moderate diarrhea. 

Atazanavir or fosamprenavir or nelfinavir or saquinavir/ ritonavir, and zidovudine or stavudine or tenofovir or abacavir or didanosine, and lamivudine or emtricitabine... 

Drugs that may affect zidovudine include acetaminophen, atovaquone, bone marrow suppressive/cytotoxic agents (eg, adriamycin, dapsone), clarithromycin, doxorubicin, fluconazole, ganciclovir, methadone, nelfinavir/ritonavir, phenytoin, probenecid, ribavirin, rifamycins, stavudine, trimethoprim, and valproic acid. 

TC Lamivudine ABC Abacavir d4T Stavudine ddC Zalcitabine ddl Didanosine TDF Tenofovir ZDV Zidovudine, also abbreviated as AZT FTC Emtricitabine NVP Nevirapine DLV Delavirdine EFV Efavirenz RTV, r Ritonavir Pl/r Ritonavir boosted protease inhibitor SQV Saquinavir IDV Indinavir LPV Lopinavir NEV Nelfinavir APV Amprenavir ATV Atazanavir DRV Darunavir... 

Inpatients with no prior antiretroviral therapy, a randomized trial found atazanavir equivalent to efavirenz when both were part of a 3 drug combination including zidovudine and lamivudine another trial found atazanavir equivalent to nelfinavir when both were part of a 3 drug combination including lamivudine and stavudine... 

A 40-year-old HIV-infected woman receiving stavudine, lamivudine, nelfinavir, and co-trimoxazole developed dyspnea, dysphagia, and vomiting with lactic acidosis (serum lactate 9.4 mmol/1) and hepatomegaly. Despite ventilation for respiratory failure she died after 5 days. Autopsy showed massive hepatomegaly with steatosis. 

Wood R, Phanuphak P, Cahn P, Pokrovskiy V, Rozenbaum W, Pantaleo G, Sension M, Murphy R, Mancini M, Kelleher T, Giordano M. Long-term efficacy and safety of atazanavir with stavudine and lamivudine in patients previously treated with nelfinavir or atazanavir. J Acquir Immune Defic Syndr 2004 36(2) 684-92. 

At the present time, there are at least 14 compounds that have been formally approved for the treatment of human immunodeficiency virus (HIV) infections. There are six nucleoside reverse transcriptase inhibitors (NRTIs) that, after their intracellular conversion to the 5 -triphosphate form, are able to interfere as competitive inhibitors of the normal substrates (dNTPs). These are zidovudine (AZT), didanosine (ddl), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), and abacavir (ABC). There are three nonnucleoside reverse transcriptase inhibitors (NNRTIs) — nevirapine, delavirdine, and efavirenz — that, as such, directly interact with the reverse transcriptase at a nonsubstrate binding, allosteric site. There are five HIV protease inhibitors (Pis saquinavir, ritonavir, indinavir, nelfinavir, and amprenavir) that block the cleavage of precursor to mature HIV proteins, thus impairing the infectivity of the virus particles produced in the presence of these inhibitors. 

Calegari J, Lorenzana R, Cheyer C, Gang DL, Higgins TL. Lactic acidosis and fulminant hepatic failure in a patient treated with didanosine, nelfinavir and stavudine. CUn Intensive Care 1999 10 61-3. 

System affected by the adverse event Stavudine + nevirapine -t ritonavir (n = 41) Stavudine + nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine -t nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine + nelfinavir (n = 52)... 

Successful treatment of human immunodeficiency virus (HIV-1) infection has been achieved through successful implementation of highly active antiretroviral therapy, frequently referred to as HAART. This involves simultaneous administration of both nucleoside and nonnucleoside reverse transcriptase inhibitors and one or more protease inliibitors. The common nucleoside reverse transcriptase inhibitors are the thymidine analogs didanosine (ddl), lamivudine (3TC), and zalcitabine (ddC) and the non-thymidine analogs abacavir (Ziazen), stavudine (d4T), and zidovudine (AZT). The nonnucleoside reverse transcriptase inhibitors include delavirdine, efavirenz, and nevirapine. The protease inhibitors include indinavir, nelfinavir, ritonavir, and saquinavir. Response to therapy is monitored by quantification of HIV-RNA copies (viral load) and CD-4+ T-lymphocyte count. Successful therapy is indicated when viral load is reduced to <50 copies/mL and CD-4+ count >500 per mL. 

Nelfinavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine) Saquinavir-ritonavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine)... 

ABBREVIATIONS EFV, efavirenz 3TC, lamivudine AZT, zidovudine TDF, tenofovir disoproxil fumarate d4T, stavudine LPV/r, lopinavir/ritonavir coformulation FTC, emtricitabine NVP, nevirapine ddl, didanosine ATV, atazanavir fosAPV, fosamprenavir RTV, ritonavir IDV, indinavir NFV, nelfinavir SQV, saquinavir. 

Skowron G, Leoung G, Hall DB, Robinson P, Lewis R, Grosso R, Jacobs M, Kerr B, MacGregor T, Stevens M, Fisher A, Odgen R, Yen Uebeiman B. Pharmacokinetic evaluation and short term activity of stavudine, nevirapine, and nelfinavir therapy in HIV-l-infected adults. J Acquir Immune DeSc Syndr 200i) 35, 351. ... 

In an early pilot study, eombined nelfinavir and stavudine was well tolerated, and the adverse effeets were similar to those seen when stavudine was given alone, although the incidence of diarrhoea did inerease. The manufacturer of nelfinavir notes that no clinically significant interactions have been observed with stavudine. - ... 

Pedneault L, EUon R, Adler M Anderson R, KelleherT, Knuf C, Kaul, Kerr B, Cross A, Dunkle L. Stavudine (d4T), didanosine (ddl), and nelfinavir combinaticm therai in HIV-infected subjects antiviral effect and safety in an or oii pilot studjy. 4 Ccnference on Retroviruses and Opportunistic Infections, Washington, 1997. Abstract 241. 

Simultaneous didanosine, folic acid, ganciclovir, lamivudine, nevirapine, pyrazinamide, ranitidine, rifampin, stavudine, sulfamethoxazole, trimethoprim, zidovudine Noninterfering adefovir, amprenavir, delavirdine, efavirenz, fluconazole, indinavir, itraconazole, methadone, nelfinavir, oxazepam, pyrimethamine, rifampin, ritonavir, saquinavir, zalcitabine... 

Aymard, G. Legrand, M. Trichereau, N. Diquet, B. Determination of twelve antiretroviral agents in human plasma sample using reversed-phase high-performance hquidchromatography, J.Chromatogr.B, 2000, 744, 227 - 240. [amprenavir efavirenz indinavii nelfinavir ritonavir saquinavir abacavir didanosine lamivudine stavudine nevirapine zidovudine]... 

Simon, VA. Thiam, M.D. Lipford, L.C. Determination of serum levels of thirteen human immunodeficiency virus-suppressing drugs by high-performance hquid chromatography, J.ChromatogrA, 2001,913,447-453. [zalcitabine lamivudine stavudine didanosine zidovudine nevirapine abacavir indinavir delavirdine nelfinavir saquinavir ritonavir efavirenz]... 

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