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which combo leaves me with more options?
Nov 21, 2005

i have never taken meds...my tcells are 190 and my VL is 3,000 my choice is between sustive/truvada or viramune/epzicom. which drug is better for sequencing? does either combo have less side effects as far as loss or gain of fat? thank you and my best to you guys on the body...

Response from Dr. Wohl

Truvada = tenofovir + FTC Epzicom = abacavir + 3TC

The good news is that the overwhelming majority of people taking either regimen can expect to get a viral load that becomes undetectable. Your viral load is low which makes it almost a shoe-in for a drop to less than 50 copies.

So, I would not be too worried about failure. If you can't help it, then rest assured that the most likely mutations that would develop with each regimen would be the same - namely the M184V mutation confering resistance to 3TC and FTC and the K103N mutation leading to very reduced viral susceptibility to Sustiva and Viramune.

With prolonged on going replication of HIV in the face of drug treatment you could start to get mutations to the thrid drug in each regimen. For Truvada, resistance to tenofovir could develop although this is rare in clinical trials. The K65R mutation reduces the effectiveness of tenofovir and most all other drugs in the nucleoside (NRTI) class. Resistance to the abacavir in Epzicom typically involves development of the L74V mutation which is not as bad and leaves a couple of more NRTI options for salvage.

I think the differences as far as sequencing here, though, are pretty minimal given most people do not virologically fail these meds when taken faithfully and that mutations to the tenofovir and abacavir are the most rare and usually the last to emerge. Clinical trial data as well as tolerability, frequency of dosing, pill count and similar convenience issues woul dbe more important in my calculus of which to start.

DW



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