New Addition to Current Regimen: AZT? Any thoughts?

[HelloGoodbye]

So, this is my first post. I have referred to these forums and they have been great for my peace of mind!  So, here it goes, my numbers first:

DATE     CD4      VL     NOTES
6/8/2005     428      20,112     
10/7/2005     399      15,978     
1/31/2006     360      25,056     
5/12/2006     300      20,737     
8/29/2006     318      19,250     
1/16/2007     318      27,200     
3/15/2010     68      680,000     Started Atripla on 3/19/10;  Dapsone 100 MG; 680,000 VL
4/22/2010     159      353         
6/22/2010     187      290     
10/15/2010     95      65,000     Possible lab error or medication resistance
10/26/2010    131    78,000     Confirmed drug resistance to Atripla
11/18/2010      -        -             New regimen: Isentress 400MG, Norvir 100MG, Prezista 600MG; Dapsone
12/17/2010   262      249         
2/18/2011     237      -             Undetectable!
5/20/2011     283      159         Discontinued Dapsone 100 MG
6/21/2011     215      113         Doctor no worried, says "it happens" and the VL went down so that is good.
9/20/2011     210      278         New Regiman:  Added AZT will start on 9/29/2011
11/17/2011                             Next Labs

QUESTION:  Based on my ID history, do you think I should be reluctant in adding this third class of drugs into my regimen?  I knew that in time, I would need that third class, but does it have to be AZT?

Has anyone been prescribed AZT recently, what is your experience?

Has anyone been prescribed AZT in the past, how was your experience?

I trust my doc, but my BF (who's neg) has more reluctance than I do, and he wants us to look at other alternatives.  Unfortunately, my doc says there are not too many options for me at the moment.  I've been luckly with ZERO side effects with my current regimen, so I may not be affected by AZT with respect to side effects. Are we (my BF and I) worrying too much?

Any thoughts would be helpful all! 

[newt]

Strictly speaking Prezista + Isentress is 1 drug short of a regulation combo so adding something else seems a good move.

But I'd be reluctant to add AZT in preference to other drugs from the same class.

There are a few very specific resistance situations where AZT might be useful but I would be surprised if AZT was the best single nuke to add to your current combo. AZT has a poor long term side effect profile.

Depending on the make of viral load test the clinically relevant cut-off for "undetectable" could be <250 not <40 I would check. You might not need more drugs.

 - matt

[HelloGoodbye]

Thanks, Matt!  I appreciate the feedback and agreed with you about the poor long-term side effects.

My labs use I believe a <48 copies test for viral load testing.

Do you think I should maybe go back to my doc and say, "hey test me again in one month w/o AZT?" I too thought it was too harsh to just start such a harsh med.  But my doc, as I said in my post, is well regarded in the W. Village/Chelsea area in NYC.

Has anyone had any GOOD experiences on it?

[Ann]

Hi HG, welcome to the forums.

Do you know what, exactly, you are resistant to? There are three drugs in Atripla from two different classes.

[buginme2]

Why did you wait so long before starting treatment (you mention you are in New York, why didnt you (your doctor) follow US treatment guidelines?

What are you resistant too?

Why are you not on a standard regiment of 2 nrti's plus a 3rd (pi, nnrti, II)?

Maybe its the lack of info..but being only on 2 different types of medication, a PI and II and having your doctor say "dont worry it happens," and offering to add AZT instead of the other newer nrti's.  Something isnt sitting right.

[Miss Philicia]

But my doc, as I said in my post, is well regarded in the W. Village/Chelsea area in NYC.

He may be well regarded but he's not giving you proper treatment for HIV. Switching you from Atripla to a sub-standard regimen of only two meds (Norvir is only a booster) is negligent, then wanting to add AZT to the mix 10 months later just makes no sense. Aside from being negligent with putting you on a 2 med regimen, why is he now wanting to add AZT instead of the preferred use of Truvada? It would have made more sense to just have switched you to Isentress + Truvada a year ago.

Personally I'd find another doctor, unless you're not communicating effectively what your doctor is doing. It's not like finding one for HIV in Chelsea is difficult.

[HelloGoodbye]

He may be well regarded but he's not giving you proper treatment for HIV. Switching you from Atripla to a sub-standard regimen of only two meds (Norvir is only a booster) is negligent, then wanting to add AZT to the mix 10 months later just makes no sense. Aside from being negligent with putting you on a 2 med regimen, why is he now wanting to add AZT instead of the preferred use of Truvada? It would have made more sense to just have switched you to Isentress + Truvada a year ago.

Personally I'd find another doctor, unless you're not communicating effectively what your doctor is doing. It's not like finding one for HIV in Chelsea is difficult.

Thanks for the input, that was helpful.  I didn't know it was a sub-standard regimen (isentress+prezista comb).  I will research more about the truvada as well as an alternative.

[HelloGoodbye]

Update:  my doc confirmed that unfortunately I am also are resistant to truvada.  he said hei usually like that drug too....the only thing I'm not resistant in that class is AZT and zerit - zerit has worse side effects, thus AZT.

I am seeking a second opinion, but if AZT is what is left, I am more than happy to do so.

[Miss Philicia]

He's correct that zerit is worse than AZT. Still, he shouldn't have had you on the previous combination that you're on. If he though you should be on AZT with those other meds then how does he account for not putting you it 10 months ago?

[newt]

Ah difficult, rare but sound clinical choice maybe

AZT in these circumstances is recommended given with 3TC. I am happy to explain the generally (nerdy) principles of why. Perhaps your doc is responding to a desire on your part to take the least amount of drugs that will be effective? dunno...

It would be interesting to know which NRTI mutations your HIV has, but if you are happy with your doc's answer re: AZT/resistance, maybe them letters and numbers is too much typing. In many cases of resistance to the 2 drugs in Truvada you can still effectively use this medicine. But it does depend on the exact mutations, and your doc has certainly checked this.

- matt

[SoSadTooBad]

HelloGoodbye, my first combo was Combivir (AZT/3TC) and Sustiva.  I had no issues with AZT, other than some minor "heartburn" like effect right after I took it.  I found taking it with some crackers or with a meal made it very tolerable, and I had good results with it.

I think I did a little better in terms of CD4 response when I moved to Atripla, but overall, AZT was pretty good to me.  Best of luck to you...