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Should I simplify?

Dec 26, 2002

I have been taking Crixivan & Combivir for 5 years with good results: viral load usually under 50 and cd4 count around 1000. I'm thinking about travelling abroad for a year or so and am wondering about simplifying my regimen so that I am not so restricted with water intake and eating times/restrictions, etc. I was recommended to look into Trizivir. What is your opinion about switching after 5 years of successful treatment? I am very excited about the possibility of an easier regimen, eating grapefruit again, and not worrying so much about my eating times and copious water intake! Please advise - Thanks.

Response from Dr. Boyle

I think simplification is generally a good idea for just about everybody, but in your case it almost sounds like a no brainer. The travel you describe is likely to lead to problems with strict adherence, especially to the time, diet and fluid requirements associated with your current regimen. Trizivir (AZT + 3TC + abacavir) has been shown to be relatively effective in patients switching to it with a viral load <50; however, there is a higher failure rate with patients who have had prior nucleoside analogue experience and have already accumulated some nucleoside analogue mutations, e.g., TAMS or M184V. Therefore, if this is not your first regimen that includes nucleoside analogues, I would be reluctant to use Trizivir alone. If it is your first regimen, and you have always had a viral load <50, you are likely to do fine with Trizivir, however, given your long exposure to Combivir (AZT + 3TC) I would still be worried that you may have some mutations that are lurking in the background that may increase your risk of failing that treatment. Therefore, if you were set on Trizivir, I would consider adding a non-nucleoside (efavirenz would be my preference, but nevirapine would be acceptable too) since the addition does not make the regimen much more complex (just 1 or 2 pills more) and does not significantly increase toxicity or side effects. Finally, given your travel plans, I would consider a simplified once-daily regimen (e.g., efavirenz + tenofovir + 3TC), which is about as easy and potent a regimen as is currently available. Good luck and Bon Voyage!

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