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Switching to Epzicom

Mar 2, 2006

I have been undetectable and feeling great for over 5 years now by taking Trizivir and Viramune (along with Androgel) - one tab each twice a day. My doctor suggests that I switch to Epzicom, Viramune, and Viread once a day so I will no longer be taking the AZT that is in Trizivir. My kidney and liver are fine. It is mentally difficult to stop a drug combination that is working. He feels we should get off the AZT before more fat redistribution and other problems develop. How neccesary and risky to switch meds? Thank-you

Response from Dr. Young

Thanks for your post.

You might read some of my other simplifying and changing posts to get a sense of where I stand on this issue-- if you've been doing well for 5 years on treatment, there's little rush to change what seems like a very successful regimen for you.

There are studies that suggest that using a triple nucleoside with a non-nuke (the studies were with efavirenz) aren't obviously any better than using a dual nucleoside with the NNRTI. Given this, it wouldn't be unreasonable to switch from AZT/3TC/abacavir (Trizivir) to 3TC/abacavir (Epzicom, Kivexa) I wouldn't add tenofovir (Viread) to the mix because of the above point and because of studies that showed that the combo of 3TC + abacavir+tenofovir actually performed poorly-- and therefore might be less potent than the sum of its parts.

AZT has been linked to a low rate of lipoatrophy in some studies, there are other large studies that suggest that most lipodystrophy occurs in the first months of treatment, if it occurs at all. On balance, I use other factors to decide whether or not to drop AZT-- things like anemia, nausea or most commonly to switch to a once- rather than twice-daily treatment.

If you were my patient and not having any symptoms of fatigue, nausea or fat changes, I'd proceed slowly and carefully. One option that makes sense to me is to switch from Trizivir +nevirapine (Viramune) dosed twice daily to Epzicom (once-daily) and change the nevirapine dose to all once-daily. This could give you a three pill, all once-daily regimen.

I hope this helps, BY

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