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Epzicom or Truvada a clear winner?
Oct 2, 2005

Greetings from overseas more precisely Denmark (a small country in northen Europe). Thanks for your excellent services and wealth of information on your website. I visit you website several times a week to get the latest news and read your replies with great interest. I am a young man in my late twenties and was diagnosed hiv+ a little less than a year ago. Since my diagnose I have changed meds two times. Started on Kaletra and Combivir this quickly made my VL undetectable and gave a modest boost to my CD4 counts (from 34 to 207 in 5 weeks). Changed the Kaletra to Sustiva (here under the brand Stocrin) two months ago since I wanted a once daily treatment with less pills and fewer side effects (especially the diarrhea was bad from Kaletra). Two weeks ago I changed the Combivir to Epzicom (here under the brand Kivexa). I have perfect adherence to my pill intake which is down to 2 pills before nightime now. So far I have tolerated both drugs with almost no side effects. I especially feared the potential psychiatric side effects from Sustiva and hypersensitivity reaction from the Abacavir part in Epsicom. So far no problems.

The healthcare here is general very good but when it comes to antihiv therapy also seems to be very conservative. Meaning that mostly well investigated drugs are used. Which is of course is not bad at all.

When I read through your forums and your replies it seems that Truvada it much more prescribed and favoured over Epzicom in the US. Is this mainly due to the potential hypersensitivity reaction from the abacavir part of Epzicom? Both drugs are once daily pills.

I know that no results have so far been released comparing Truvada versus Epzicom. Though both Epzicom and Truvada have been compared against and have somewhat been concluded to be Combivir superior. Truvada especially due to the better tolerability and Epzicom due to the better CD4 increases. Both drugs seem to have very low if not none mitochondrial toxicity.

If one does not develop the hypersensitivity reaction from Epzicom can this drug then be concluded to be better than Truvada? Or is Truvada better than Epzicom since it is a nucleotide (reaches even more cells in the body and the body needs one step less to process nucleotides compared to nucleosides). Furthermore Truvada has longer halftimes than the active drugs in Epzicom which means late doses are lesser problematic with Truvada.

Since I want the best treatment available please elaborate on which drug you find the best Epzicom or Truvada. That is if no resistence is present and one have no other health issues (ex. bad liver or kidneys). From my research its seems that if one does not develop the hypersensitivity reaction from Epzicom this regiment is preferable since the active ingredients in this pill have been studied more intensively and for a longer period than Truvada which still have issues with decreased bone densitym potential longterm kidney toxicity more precisely Fanconi's syndrome and Truvada have more drugs interactions with other drugs compared to Epzicom. So I am a bit confused why you in some replies seem to favour Truvada over Epzicom (and no I am not a shareholder of GlaxoSmithKline!)

Found this good site which compares the different nuke combi. pill treatments but the site is a bit outdated. http://hopkins-aids.edu/publications/report/nov04_1.html

Best regards

T

Response from Dr. Pierone

Hello and thanks for posting. I think that Truvada and Epzicom are both very good agents. For patients that have not been exposed to either one, and are trying to decide which one to choose, the available data seems to favor Truvada. This is based mainly on the challenges posed by abacavir hypersensitivity reaction. However, for someone on therapy, who is already past the early risk period for hypersensitivity, there is no reason to switch to Truvada. As a general elaboration there are many patients who are doing great on antiretroviral regimens that have been proven inferior to other cocktails based on large, randomized trials. Just because one regimen turns out to be better for treatment-nave patients does not mean that patients already on therapy and doing well need to change anything. This would be comparing apples in oranges and does not hold up scientifically.



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