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Sustiva and Epzicom vs. Truvada
Nov 10, 2004

Hi...This is less a question than what I suppose may come off as a testimonial. I began treatment last month with a viral load of 330k and a cd4 of 230. My regimen consisted of once-daily Sustiva & the new once-daily epzicom. I developed a full body rash starting on day 12 and replaced Epzicom with Truvada on day 15, due to hyphersensitivity. The rash disappeared within 2 days. Aside from the slight "high" feeling one hour after taking meds (Sustiva), I have had no troublesome side-effects & generally feel great. The 2 week labs showed a VL of 2207! and a cd4 of 437. Hopefully, the Truvada will maintain & continue this progress. Have you seen a similar result in your patients with this regimen?

Response from Dr. Young

Thanks for your comments.

Both of the new fixed-dose combination pills, Epzicom and Truvada have been shown to be very effective and potent in combination with efavirenz (Sustiva). As you have experienced, a percentage of persons who take Epzicom (abacavir + 3TC) can develop an allergic reaction to the abacavir component of the medication-- resulting in the need to permanently discontinue the medication. Aside from this issue, Epzicom appears to be very well tolerated with very good long-term safety, with extensive clinical trials experience (using this NRTI combination) with both NNRTIs and PIs.

Truvada (tenofovir + FTC) is a newer combination that builds on the extensive experience of tenofovir (and extrapolates from the huge positive experience of 3TC). This medication is also very well tolerated; drug allergic reactions are much less common and clearly not as significant as for abacavir. Truvada (or its components) has been evaluated in two ongoing clinical studies. One of these studies, Gilead 934, had preliminary 24 week data presented at last week's ICAAC meeting-- these data are very positive and suggest that the medication is better tolerated than the highly endorsed Combivir (AZT + 3TC) backbone, in combination with efavirenz.

So, yes, we've seen very encouraging results from both combinations that you've been on--both in important clinical trials and within our own patients. Both of these regimens offer 2 pill, once-daily, very simple and very potent combinations.

Thanks for your comments-- I'd welcome reports from other readers. BY



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