Dear doctors, I'm on Gilead "extended" 903 clinical trial, finishing in 3 months' time. My medical insurance has told me that they will not provide me with VIREAD, since that drug is only provided to all-drug-resistant patients. Could my current cocktail (VIREAD+3TC+EFV) be changed to AZT+3TC+EFV? My viral load has been undetectable for the last 4 years and my CD4s are over 35% and 700. Kind regards from Argentina, Worried

One of the reasons that we do research studies is to determine optimal therapy. The 903 study demonstrated the superiority of Viread over d4T and clearly supports its use in first-line therapy. If your insurance company is denying it, this is simply a financial decision to lower their expenditures. This may work out quite well for them, but perhaps not so good for you. I suggest that you vigorously protest their decision.

If you are unsuccessful, the substitution of AZT in place of Viread will probably work out fine (although most switches are from AZT to Viread in order to lessen toxicity). Best of luck to you and let us know if you are able to influence these perfidious purveyors of pitiable medical insurance. Thanks for posting and let us know how things turn out.