Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Switching when stable

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ladybug:
Hi, I'm a newcomer to the site but longterm HIV+ person. I've just changed docs and she's suggested a treatment change. I'm on zerit, abacavir & katetra. She wants to switch zerit to tenofovir and add epivir (which I've been on in the past). I'm of the "if it's not broken, don't fix it" mentality, but am having lipoatrophy issues that could be related to zerit. I've been on these meds for almost five years, viral load undetect. and high cd4. HIV+ 20years. Any help would be greatly appreciated!

newt:
Switching the Zerit for something is a good idea if you are having fat loss. 

However, just swapping the Zerit for Epivir, or swapping both Zerit + abacavir for Truvada (tenofovir + FTC) should be sufficient unless you have some kind of nuke resistance that means 3 nukes are a good idea.  There's no special reason to be on the nukes otherwise.

Since you are already on abacavir you might discuss using Epzicom (abacavir + Epivir in one handy pill).

- matt

ladybug:
Thanks. I know I have nuke resistance. I did AZT monotherapy for years before combo therapy was even an option. Just scary to change when drugs are working. I've only added or changed when there's an issue - I guess I can consider fat loss an issue.

gerry:
Do you know how extensive your nuke resistance might be after the AZT monotherapy?  That is, do you have access to your genotype test?  It would help to have this to be able to determine what switch would be best for you.  Also, AZT and Zerit share some resistance patterns, so the fact that your current combo is working in keeping your viral load down may indicate that your resistance to nukes may not be bad.  However, if you did have resistance to Epivir (which you have taken in the past; again the genotype test might show this), then it would not count as an active drug, but the resistant strain it induces makes the virus more responsive to AZT, Zerit and tenofovir (but only if the Epivir remains in the combo).  Lipoatrophy would be a good reason to switch, but the choices, as Matt pointed out, would depend on what type of resistance you have.

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