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

Switching from Combinvir to Trizivir?

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nick2046:
Hi, i've an urgent question regarding my treatment but i want a 2nd opinion. 

I'm on Combivir together with a Non-Nucleoside Reverse Transcriptase Inhibitors (Sustiva).  My CD4 has been increasing slowly over the years & is now 240.

The doctor wants to switch to another nucleoside reverse transcriptase inhibitors (NRTIs), Trizivir.  It's essentially same as Combivir but it contains one more drug, 300mg of ZiagenŽ (abacavir).  Often, ppl associate more drugs causing more interactions & have more side effects.

My question is, is it sensible to switch, as both drugs have the same dosage.  Doctor says Combinvir has this Long Term side effect (she didn't bother to explain any further) but all these drugs are basically poison to other ppl, each drug has its side effect.  Moreover, i don't think i'll live a long life; so, is it worth the trouble?

newt:
Hello Nick,

First, there's no reason to think you won't have a long life, especially now your CD4 is over 200.

Second, there's no obvious reason to swap Combivir for Trizivir. If Sustiva + Combivir is keeping your viral load down and your CD4s up, adding another drug is unnecessary.

A better switch would be to Truvada (tenofovir + FTC) or Epzicom (abacavir +3TC).  This would get rid of AZT and avoid the long-term side effects connected with this drug (fat loss in the face and limbs, & perhaps heart muscle damage). 

- matt

nick2046:
Thank you for replying & your advice. 


When i said i won't live for too long, it has nth to do with being infected.  Average lifespan around the world is around double what it was 200 years ago.
It is now around 65 for men and 70 for women; i'm way past my 1/2 life.  :'(

My thought exactly.  She did mention Lipodystrophy but didn't bother to further explain it, as if i was too stupid to understand.  She also gave me wrong info on Trizivir saying i only needed to take 1 tablet a day.

I'd've been dead if i was born just 25 years earlier, so i'm on stolen time; and i deserve that stolen time. ie best drug diet i could get.  Thanks.   

edfu:
I participated in an experimental study, ACTG 5095, which compared Combivir + Sustiva vs. Trizivir + Sustiva vs. Trizivir alone.  The results of the study in brief:  1.  Trizivir alone is not recommended.  2.  There is NO advantage whatsoever in taking Trizivir (3 drugs) + Sustiva vs. Combivir (2 drugs) + Sustiva.

There is no reason I can think of for recommending a switch to Trizivir from Combivir.  I humbly suggest your doctor is wrong.  ACTG 5095 proved that 4 drugs are not necessarily better than 3 drugs.

When the study ended and it was unblinded (nobody knew who was on which of the three regimens), I learned I had been on Trizivir + Sustiva.  I decided to drop the AZT component and switched my drugs to Epzicom + Sustiva.  Three months later, my CD4 count went up 300. 

I knew I didn't have a bad reaction to Ziagen (abacavir), since it was part of the Trizivir.  You would have to be concerned with that, but my suggestion, like Newt's,  would be to switch to Epzicom + Sustiva.  Get rid of the AZT.   
   

lydgate:
While we're on the subject of getting rid of things -- try, if you can, to get rid of your pessimism regarding your life-span (and other things). Don't get me wrong, I love bitching and moaning and whining and complaining and kvetching as much as the next guy; but I do think that's different from going around thinking I'm going to die as per the statistical average life-span for men in the West today! Statistics apply to large groups; they're well-nigh useless when applied to "predict" what will happen to a single entity, in this case you.

I, too, would have been dead if I'd been born 400 years ago (bubonic plague perhaps), or 200 years ago (consumption maybe) or 100 years ago (cholera epidemic possibly) &etc... What I'm trying to say, Nick, is that you were not born 25 years ago; you were born when you were born. The phrase "borrowed time" is all very well as the title of a memoir (Paul Monette) written 15 years ago; but, with access to medical care and a good response to treatment, why go through life thinking you're borrowing from an account that might run dry soon?

Just saying.

Jay

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