Tivicay/Epzicom or Tivicay/Truvada or ...?

[SCCL]

Hi:

I'm taking Atripla and want to change because of cognitive issues.

In 96 started d4t/3tc/viramune. I switched to Sustiva/Epzicom in 2002 because of lipoatrophy.  I switched to Atripla in 2007.

I've narrowed the choices down to Tivicay/Truvada or Tivicay/Epzicom. I don't want to take Complera or Stribild because of the food requirements. 

* My concern with Epzicom is that I took it for 5 years. I only switched because of abacavir and the studies that showed potential cardio problems.

** My concern with Truvada is bone related.

I've had osteopenia since 2003. No one told me (before or after the bone loss) that tenofovir could cause bone loss. My bone density (osteopenia) is about the same as it was in 2003.

Do you know whether going off Tenofovir would potentially improve my osteopenia or at least prevent it from getting worse?   

*** Finally, Is it common to do antiviral resistance testing when a person has my antiviral med history?

I've never failed on combo.

Thank you for your time.

[vertigo]

My understanding is that the potential for cardiac events with abacavir was found in some studies but not all.  Tenofovir, on the other hand, is widely known to cause bone density loss.  (However, the pro-drug variant TAF may fix this.)  The biggest problem with abacavir is the hypersensitivity issue, but since you took it before this must not be a problem.

Since you have some issues with bone loss, the bias might be towards Epzicom.    However, the presence of cardiac risk factors could mitigate that.  Do you have any actual risk factors, or was your reason for switching just a generalized unease?

An advantage of taking Epzicom is that it will be combined with Tivicay in a single-tablet regimen.  Assuming approval, that should be available later this year.

If you haven't failed treatment, I can't see a doctor ordering a resistance test at this point.  For one thing, you would need a detectable viral load.  You don't mention it in this post, but I assume that you are presently undetectable.

What does your doctor recommend?

[SCCL]

Hi Vertigo:

Thanks for your very informative response.

I have an appt. with my dr. on Tuesday. I'm doing this research so I'm informed when I talk to him.

I'm switching from Atripla because of cognitive issues (memory loss/spacey off-kilter feeling). I've been using Sustiva since 2002 so it never occurred to me that my recent cognitive issues might be related. Reading this forum has lead me to believe that these cognitive problems may be delayed side effects from Sustiva!?  I'm hoping the switch will stop these problems.

I don't have any cardiac risk factors except I'm a male. I'm undetectable.

It looks like advantages of Tivicay/Epzicom are:

1. 1 pill once a day later this year.

2. stopping tenofovir may improve my bone density.

3. I took Epzicom for 5 years without issue, except maybe a few weeks of adjustment

4. No need to do Abacavir screening since no allergic reaction the 1st time? I'm not sure about that. Any thoughts?

Advantages of Tivicay/Truvada:

1. Tenofovir lowers cholesterol. My numbers are good but LDL is borderline (129)

2. I've been on Truvada (Atripla) since 07 so I'd only be switching out 1 drug -- Tivicay for Sustiva, which may mean fewer initial side effects??  It's been 7 years since I took Epzicom.

Are there any other pros/cons of Epzicom vs. Truvada?

Thanks.