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Zerit to Viread

May 16, 2002

Thank you for such a wonderful website. I'm taking Zerit, Epivir, and Sustiva. My levels are great (undetectable) and 405 for cd4 count. I have problems with lypodystrophy (loss of facial structure and fatty tissue in legs) and on-going problems with diarrhea. Is changing Zerit to Viread a normal change? And if that doesn't work with the side effects, remaining on Viread, and switch Sustiva to Viramune a normal change in therapy? I've been on Epivir/Zerit/Sustiva for 3 years - and it was my first regimine. -concerned

Response from Dr. Aberg

There is no data regarding the reversal of fat wasting (lipoatrophy) with the switch from zerit (stavudine, D4T) to viread (tenofovir). I suspect the switch would be safe both virologically (viral load) and immunologically (CD4)but I cannot say what will happen with the fat changes. To date, there has been very little evidence to suggest switching regimens or even stopping regimens reverses the fat accumulation and fat wasting complications. There is one study that suggested a switch from D4T to abacavir may give some improvement in limb size but these results are very preliminary.

The main reason I usually switch from Sustiva (efavirenz, EFV) to Viramune (nevirapine, NVP) is because of intolerance such as dreams, neurologic disturbances. Diarrhea can occur with any medicine although it is uncommon with the regimen you are on. I don't know if your diarrhea would improve with a switch to nevirapine.

Once-a-day dosing of Epivir
Is Epivr+Zerit+Viracept a good combo?

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