A Case Report on Zidovudine Induced Anemia and Its Management in HIV-1 Infected Patient

Patient infected with human immunodeficiency virus-1 (HIV-1) are at increased risk of developing severe hematological complications when they are in Highly active anti retroviral therapy (HAART). Although there is a proven adverse drug reactions with those drugs, but it can be manageable with some supplement therapy which had seen in this case. We report a patient infected with HIV-1 positive that he was on regular treatment with Zidovudine (AZT), Lamivudine (3TC) and Nevirapine (NVP) for the past 2 months developed with the complaints of giddiness, loss of weight and appetite. The patient diagnosed with HIV in the year 2008 and the physician started with the regimen (Stavudine (d4T), Lamivudine, and Nevirapine). While the patient was in this regimen, it caused persistent liver abnormalities, Hepatomegaly and it was identified that Stavudine induced Hepatic Steatosis. Then the patient regimen switched to Zidovudine, Lamivudine and Nevirapine. During his next review after a month, the patient was subjected to laboratory investigations which showed abnormalities in hematological parameters. Hemoglobin-3.3 g/dl, RBC- 1.06×10 6/mm 3 , HCT-8.1%, MCH-19pg, MCHC-22.7g/dl, RDW-37%. This was taken to physician desk by clinical pharmacist and it was determined that Zidovudine is the major cause for hematological abnormalities. In view of adverse effects with Stavudine and Zidovudine, the regimen was switched to Tenofovir, Lamivudine and Nevirapine. Then, 4 units of blood were transfused followed by Livogen –Z (Ferrous fumarate (250mg) and Folic acid (1.5mg) as a supplement which showed gradual improvement in hematological parameters with decreased viral load. Before initiating the Zidovudine containing ART regimen, it is essential to monitor the hematological parameters of the HIV-1 infected patient. Health care providers may consider this fact to bring good outcomes in HIV infected patients.