New Public Health Service HIV treatment guidelines say that the best way to use d4T is in combination with other anti-HIV drugs. The guidelines recommend combinations of three or four anti-HIV drugs as first treatment for HIV:

• Two nucleoside analogs (AZT+3TC, d4T+3TC, d4T+ddI, AZT+ddI, or AZT+ddC) with one of the following: Crixivan, Fortovase, Norvir, Sustiva, Viracept or Norvir and Fortovase combined.
• If one of the above combinations cannot be used, an alternative is two nucleoside analogs (same combinations as listed above) with Viramune or Rescriptor.

Dosage: The standard dose is 40mg twice a day for people weighing more than 60kg and 30mg for those that weigh less. This can somtimes be lowered to 20 mg or 15mg if side effects are a problem. d4T can be taken with or without food.

Side effects: The most common side effect of d4T is peripheral neuropathy. Peripheral neuropathy usually shows up as sharp burning pain sensations in the hands and/or legs. Early signs are a burning sensation or a numbness, like a deep pain that may come and go but always affects the same spot. Early symptoms of peripheral neuropathy are a tingling sensation in the fingertips, feet or legs. This side effect can sometimes be eliminated by using a lower dose.

Other rare side effects of d4T are pancreatitis, elevated liver function tests and bone marrow suppression. Symptoms of pancreatitis can be pains in the stomach area that go through to your back, and you should notify your doctor immediately if these symptoms occur. Your bloodwork should also be routinely checked for any signs of pancreatitis. Liver function should be closely monitored if you are taking d4T. Bone marrow suppression is monitored through your blood work. Bone marrow suppression does not occur as frequently with d4T as with AZT.

d4T and lipodystrophy: One of the side effects linked to long term use of anti-HIV drugs has been given the name lipodystrophy. This side effect shows up as loss of tissue from the face, giving the cheekbones a "sunken" look. There can also be a build up of fat around the waist causing a pot belly. Fat levels in the blood (cholesterol and triglycerides) may also increase. At first, this side effect was thought to be caused by the class of anti-HIV drugs called protease inhibitors. However, recent research suggests that some symptoms of lipodystrophy may be related to other anti-HIV drugs. Although it is not yet certain, some researchers have found that long term use of d4T may be a risk factor for some of the symptoms of lipodystrophy, such as loss of tissue from the face. One small study found some improvement in these symptoms when people taking d4T as part of their combination switched to an alternative drug.

Drug interactions: The combination of d4T and AZT is not recommended as these drugs do not work well together.

Patient assistance: The manufacturer of d4T, Bristol-Myers Squibb, has a patient assistance program for those having difficulty affording the drug. Call (800) 272-4878 for more information.