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what med goes with what med
Mar 8, 2001

I recemtly read the updated treatment guidelines which contains a table showing various combinations that are "Strongly recommended", followd by "Alternatives" and so on.(see www.hivatis.org/guidelines/AAFEB05S.PDF, page 48).

My question is this: how strictly should one consider these exact combinations. Can we not just pick more or less any three drugs to which one has no resistence? My choices are limited according to recent phenotype/genotype tests.

I am planning to go to: Abacavir, Lopinavir and Zerit. In the combos of nukes, various combos are shown but not Zerit and Abacavir. Is there any science behind this, or just that this combo hasn't been studied? (I could take DDI instead of Abacavir, since I am not resistent, but I wanted to avoid two drugs known for side-effects of neuropathy)

I will also be taking T20 as part of a clinical trial. Its such a big decision, since I know that every drug taken can lead to resistence and narrows my future options.

To repeat my question, in case I didn't express it simply enough, is there any reason NOT to combine Abacavir + Zerit with the Lopinavir I will be starting next month?

Thanks !

Response from Dr. Cohen

In general, there is no reason that you cannot do the combo you propose. The two nucleoside combos that are listed come from studies that have been done so far - and there are some combinations that are reasonable to use, even if they are not yet on the list.

I will make the assumption, since you are mentioning a t20 study, that you are not looking at your first combo, but are looking at a switch after other regimens have failed. The reason I mention this is that the combo you mention would be controversial as an initial regimen - although it might work quite well. The reason it is controversial is that, if it did not maintain full suppression, you would expect to see a mutation in the RT gene at position 184 - called 184V. This mutation happens to those on abacavir, and in your combo, is likely to be the first mutation that would occur. This mutation also causes cross resistance to 3TC as well. And if you have never taken 3TC in the past, you would have also "lost" the ability to use 3TC while it is still fully potent in some future combination. After 184V - 3TC does have some potency left - but less than what it has when fully active. This is why some would tend to use 3TC either before abacavir, or at the same time. Note that if you use 3TC before abacavir - and if you get viral rebound - you would get the 184V mutation. But fortunately, abacavir is still fully potent after this one mutation happens. So abacavir can successfully be used after 3TC, but the reverse is less true.

I would guess, based on the T20 studies I know of, that you are looking at a genotype and phenotype, which is suggesting that these three meds have the best chance of working for you. If so - then they are a reasonable combo to use. Good luck. CC



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