switching from AZT to Viramune; thought Viread would be better!?

[Ralffey]

What up?

I am on Combivir and Lexiva.
VL load is undetectable but skin is turning darker and darker.
Wanted to switch out the AZT in Combivir (AZT and 3TC) and replace it with Viread.
My kidneys are fine, but my doctor doesn't want to risk them on Viread.
I am allergic to Abacavir.

So my regime would be Viramune, Lexiva and 3TC. 
I am worried about Viramune since I am a male with tcells are over 400.
Is this a good regime? 1 non-nuke, 1 PI, and 1 NTRI.

I asked the experts on "The Body" website, and they didn't think this is a good switch.
I am also not confident that this is a good switch. Are there any troubling studies out there about black patients on Viread?

[newt]

The proposed combo would be fine.  As Viread lowers the level of Lexiva in the body,  boosting the Lexiva with a small dose of Norvir is probably a good idea.

If your kidney function is okay before you start taking Viread then the chance of kidney damage is very, very small.  Viread/3TC/Lexiva is probably simpler to take, and overall kinder on your body organs.

- matt

[gerry]

Combining Viramune with Lexiva has not been adequately studied in terms of potential interactions.  So there are no dosing guidelines available for this combo, and there is a potential drug interaction issue.  Combining Lexiva with Sustiva, for instance, causes Lexiva levels to decrease even when boosted with Norvir, so dose adjustments in the Lexiva or Norvir (depending on whether Lexiva is taken once or twice a day) is recommended.  Such recommendations for Viramune and Lexiva have not been established, so I'm not certain how your doc proposes to dose such a combo.  Is he proposing to check Lexiva levels while you are taking the combo?

I am not aware of any studies that link Viread induced kidney disease to race or ethnicity.  HIV-associated nephropathy seen in late-stage disease and linked to direct effects of the virus to the kidneys, is more common in black patients.  However, this is not linked to Viread use, either.  There are monitoring parameters for kidney function recommended when starting Viread, if you decide to go that route.

[Ralffey]

What up people,

Thanks for the replies.

Is there a real problem with me taking Viramune with my tcells over 400?
I thought they didn't reccommed it, but my doctor thinks it's OK - what gives?
The new combo would be Viramune/Lexiva/3TC.
How does this combo look?

[newt]

Sorry, being dim in my first post, read Viramune for Viread.

So, start again..

If your kidneys are fine what's the problem with Viread? People with normal kidney function tend to do very well on this drug.

Gerry is right that there are no studies on using Lexiva and Viramune together.  Based on what is known about using Sustiva (the other NNRTI) with Lexiva, you would need to use a Norvir booster to make Viread/Lexiva/3TC viable (Sustiva reduces the level of Lexiva you absorb a lot, and therefore Viramune is likely to do the same). Even then it's a bit of a punt.

Liver problems are more likely to occur in men with a CD4 count of 400+  (women: 250+) before starting Viramune. This is very well known, and the reaction can be serious, even fatal.  The prescribing info has a big, fat warning about this. Viramune is therefore avoided, or handled very carefully (weekly monitoring of Iverliver etc), if your CD4 count is at this level. (So yes there is a real problem).

Since you are allergic to abacavir, two most obvious drugs to replace AZT with are Videx or Viread. Personally, this would be the choice I would be looking at.

- matt