Tetracycline Rash

ID/CC Ail asymptomatic. HIV-positive 29-year-old male visits his infectious-disease specialist for a routine checkup; after determining his CD4 count (410), the physician decides to start him on oral zidovudine (AZT) at a dosage of 600 mg/day.

HPI Two months later, he returns to the doctor's office feeling very tired (due to anemia); he has also had two URIs and yesterday started bleeding from his gums (due to thrombocytopenia).

PE VS: slight tachycardia. PE: marked pallor; disseminated petechiae on arms and legs.

Labs CBG: decreased platelets (thrombocytopenia); decreased WBCs

(neutropenia); decreased RBCs (anemia).

Treatment Discontinue AZT and switch to zalcitabine.

Discussion AZT is used as an antiretroviral agent in symptomatic patients or in those with CD4 counts < 500. It is often combined with another nucleoside reverse transcriptase inhibitor such as ddl (an adenosine analog) or ddC (a cytosine analog). To prevent resistance, a protease inhibitor is also added to the regimen. Protease inhibitors block the proteinase that cleave the viral proteins needed to bud from the cell.

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