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Starting on Combivir

Jan 22, 2006


My doctor is starting me on Sustiva and Combivir. I was just reading an article that says that Combivir can cause facial wasting. Is that true? Should I avoid that drug altogther?

Thank you.

Response from Dr. Young

Thanks for your post.

It's true that persons starting on Combivir tend to have more initial side effects than other combination nukes, such as tenofovir/FTC (Truvada)-- there are studies that suggest that the rate of lipodystrophy might be higher among thymidine drugs (d4T and AZT)-- most of this risk is clearly associated with d4T.

In the recently published 48 week analysis of the Gilead 934 study (a study that compares Combivir to Truvada), both groups experienced an increase in weight with a larger increase in the Truvada group. There was more limb fat among the Truvada patients compared with the Combivir patients. There were no report on differences in the rate of clinically diagnosed lipodystrophy.

How does one incorporate these data? Both drugs have substantial datasets and both are recommended by the US Department of Health and Human Services. It's actually striking to me that nearly 20 years after approval, AZT remains on the recommended lists from across the globe-- I think that the potential initial side effect profile and twice-daily dosing aspects are the main liabilities of Combivir. The risk of lipoatrophy is lower than d4T, but needs to be balanced against the risks and benefits of other treatment options. This balancing act is the stuff of individualized medical options. Newer options like Truvada and Epzicom have largely replaced Combivir in our clinic, mostly because they can be dosed once-daily.

I hope this helps, sounds like it's time to discuss your thoughts with your doctor. BY

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