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Combivir therapy: Is it useful or not ?
Jan 5, 2003

Dear Sir

My young brother, 28 years old, was found HIV+ two months ago. At that time, the local doctor started to treat him with Combivir twice a day.

When I ask him to tell the doctor about combination treatment to prevent the drug resistance of HIV, yesterday, the local doctor add more one drug Videx to his regimen therapy.

According to the DHHS guidelines, I know that the Combivir and Videx are in the same category of HIV drugs (Column B of Table 4-4a: Initial Regimen - DHHS Guidelines).

Experts say that the preferred recommended starting regimen is a combination of one from column A and one from column B to prevent the drug resistance of HIV in the initial regimen.

Could you tell me that the addition of local doctor here is useful or not for my brother case to prevent the drug resistance of HIV ?

Personally, I suspect this regimen therapy because of at the beginning, the doctor has just give only the Combivir to my brother for near 2 months. After that when be asked for the combination therapy, he added more one drug in the same column to him. All of two kinds of drug are Nucleoside Analogs and they are given not at the same time as initial regimen.

As an expert of HIV treatment, please give me advise for my brother treatment case and what we should do now ?

So far, I ask my brother temporary not use Videx with his Combivir for more information about this treatment.

Thank you very much.

Response from Dr. Young

Thank you for your question.

You have an accurate read of the DHHS treatment guidelines-- as such, I agree that using Combivir alone to treat HIV is a sub-optimal approach.

The use of a triple nucleoside regimen, like ZDV/3TC/ddI, as you suggest would be a variant from the guidelines; additionally this regimen has really not had sufficient study to make it a preferred approach.

An alternative triple nucleoside regimen, ZDV/3TC/abacavir, has been extensively studied and has shown excellent performance and tolerability in persons with baseline viral loads below 100,000.

I'd prefer to see your brother use a 3-drug regimen, using the formulae put forth in the guidelines-- in the mean time, the use of Combivir alone should be discouraged, since this combination alone will likely result in the selection of drug resistant virus. Resistance virus has significant implications, in that persons with drug resistant HIV are more likely to experience premature treatment failure and have AIDS-defining events.

I have to ask where your brother lives-- if he lives in the United States or Western Europe, I'd challenge the qualifications of your brother's doctor-- persons in the developed world who are antiretroviral therapy naive should never initiate therapy with just two medications.

Please let us know how the situation turns out, and I hope that this was a useful start. -BY



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