Is switching from Trizivir + Sustiva to Kivexa+ Sustiva likely to reverse idiopathic myelofibrosis severe enough to warrant transfusions? Also, if both of these meds (which are taken once a day) were missed for three nights straight, how likely is it that resistance would occur? Viral load was undetectable 4 weeks ago, CD4 350, but cirrhosis, hepc, and pml are also present in this equation. Next viral load check isn't for two more months...

Hello,

The cause of idiopathic myelofibrosis is unknown. In fact that's what the term "idiopathic" means! Changing antiretroviral medication regimens is not a treatment for myelofibrosis, nor would it be expected to alter its course. That said, I do agree you should switch HIV medication regimens. Trizivir contains AZT, which can cause anemia in some people. Myelofibrosis also can cause anemia by a totally different mechanism. By switching off an AZT containing drug, your anemia might improve somewhat.

Your condition is complicated by hepatitis C, cirrhosis and progressive multifocal leukoencephalopathy. Close follow up with an experienced HIV/AIDS specialist is warranted.

I'm also concerned about your question related to missing three full days of your HIV medications. Certainly this increases the risk of developing resistance to one or more of your HIV medications. Talk to your HIV specialist if you are having difficulty complying with or tolerating your medication regimen.

Good luck.

Dr. Bob