ddC, trade name Hivid (also known as zalcitabine), is a an anti-HIV treatment in the same class of drugs as AZT, ddI, d4T and 3TC. These drugs are 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 AIDS lose T4 cells - one of the immune systems 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 ddC 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: Adults take 2.25 mg of ddC 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 ddC in the blood.

Side effects: ddC rarely causes the anemia or suppression of white blood cells that are the major problem with AZT. Side effects of ddC 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 ddC 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 ddC, 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 ddC 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.

Drug interactions: If you are starting radiation therapy, amphotericin B, pyrimethamine, sulfadiazine, intravenous Bactrim, ganciclovir, pentamidine, or acyclovir, you should discontinue ddC until you are stable on the other drugs. Combining ddC with ddI, d4T or 3TC is not recommended, as these drugs do not work well together.

Hoffmann-La Roche, who makes Hivid, has an Assistance Program for people having trouble affording the drug. Call (800) 285-4484 for more information.

The Simple Facts Project is a program of The Network. If you need help finding out whether or not a specific drug or therapy is covered by private or public insurance, contact The Network at (800) 734-7104. This information does not intend to promote or endorse any specific treatment for any health related condition.

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