My meds and drug-induced anemia.

It's been almost two weeks since I confirmed that I am anemic, and my blood count history shows that it could be drug-induced.

I started taking anti-retroviral (ARV) drugs on July 31, 2012. I started trial on nevirapine (Nevipan) one tablet once a day, and lamivudine + zidovudine (Avacomb) combi twice daily for two weeks. I also started taking isoniazid and cotrimaxazole as prophylaxis for TB and pneumonia, respectively. Before I took the meds, I had a CBC, and my hemoglobin was 140.

After two weeks, I passed the trial period for nevirapine without experiencing the usual side effects. I was happy because most people I talked to were allergic to nevirapine, and I'm glad the first set of meds prescribed to me worked without causing any adverse side effects. So the doctor upped my nevirapine dosage to twice daily, and continued with the rest of my other meds.

After another two weeks, or one month after I started taking meds, I had another CBC. My hemoglobin count was lower at 130, but still ok. The nurse told me that the reason I need to take regular CBCs was to ensure my hemoglobin doesn't drop, because zidovudine is known to cause drug-induced anemia.

Fast forward: October 5, 2012. I went to RITM on an emergency case because I developed blisters on my body. I was also very pale. It's been a little more than two months since I started taking ARV drugs. The night before, I stopped taking my evening dose of nevirapine, because I thought the blisters might have been a side effect of nevirapine. But after seeing the doctors at RITM, I learned that what I had was not an allergic reaction to nevirapine, but herpes zoster, which was possibly caused by a combination of stress, and a weak immune system. Again, I was relieved because I didn't want to change my meds. I was afraid of taking efavirenz, which was the usual replacement for nevirapine.

I also took another CBC that day, and the result was alarming. From 130 just a month ago, my hemoglobin count dropped to 86. The doctor immediately removed zidovudine from my meds and replaced it with tenofivir once daily. He also asked me to take ferrous sulfate help combat anemia.

After 10 days, on October 15, I visited RITM for a checkup on my herpes zoster, which has already dried up, and to take another CBC. As I told in a previous blog entry, my hemoglobin count dropped further to 74. Apparently the effect of zidovudine takes time to wane. All I can do now is to rest, wait, and make sure I eat iron-rich food and take iron supplements to combat the anemia.

I'll be going to RITM again on monday for another CBC. Hopefully I hear good news.