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Truvada versus Epzicom?
Dec 23, 2004

Diagnosed in 2002, I have been getting labs done, every 6 mos. & monitoring CD4 & Viral Load, holding on meds. Per my Dr's advise. My CD4 fell from 400 to 48 between my previous labs and current, and corresponding Viral Load of 230,000 fell to 30,000. We did another CD4 test to see if there was something up with the dramatic drop that turned out to give me a CD4 of 120. I was put on Bactrum and told that meds were going to be needed. I had done quite a bit of research myself on initial regimens, and had thought that the following might work well: Sustiva (Efavirenz) + Truvada (tenofovir DF + emtricitabine) - I like that the (tenofovir DF) is a Nucleotide analogue that bypasses phosphorylation, given that it is already chemically activated - possibly saving my body from having to do more work. I also felt emtricitabine, A fluorinated analog of lamivudine with a long intracellular half-life allowing for once daily dosing would be a good option helping to simplify the regimen - 2 pills/day. Well - the Dr. said something about tenofovir + emtricitabine causing a similar mutation, and it would be better to hit the virus from 3 different angles ... I don't quite understand what he meant, and he seemed to move on quickly and recommended Sustiva + Epzicom (abacavir sulfate and lamivudine) I was leery about the stated 7% of people who can have severe allergy to the abacavir - He said it is easy to diagnose, and meds would be switched if any allergy symptoms occurred. I guess I'm wanting to better understand the mutation issue on the previous mix, and get a second opinion about the Sustiva/Epzicom treatment.

Thanks - 26MaleInOhio

Response from Dr. Pierone

Truvada and Sustiva are more commonly prescribed together than Epzicom and Sustiva. Truvada is safer than Epzicom because of the risk of hypersensitivity related to the abacavir (Ziagen) component of Epzicom. Sustiva can sometimes cause rashes that may be difficult to distinguish from an abacavir hypersensitivity reaction and this is another challenge with this combination.

Truvada is composed of tenofovir (Viread) and emtricitabine (FTC, Emtriva) and these agents don't lead to a similar mutation if virologic failure occurs. Emtriva is associated with the M184V and tenofovir with the K65R. So there is not a resistance-related rationale to not use this combination.

Also, Epzicom and Combivir have been shown to equally effective in a large head to head study. Truvada beat Combivir in a similar study, so it is logical to think that Truvada will be proven better than Epzicom. The ACTG (AIDS Clinical Trials Group) will be planning a direct comparison so eventually we will have more definitive information.



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