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Trizivir vs combivir
May 20, 2006

Hi Docs! Thanks for all your great insight on these forums, which I have found immensely helpful. After several years of passively reading your comments, it's finally time for me to ask a question. I've been on Trizivir + Sustiva for 3 years (first regimen). Fully suppressed and CD4s now up to 625 and no noticeable side effects yet (although I'm always a little worried about the long term effects of the AZT component of the Trizivir). I recently saw the results of a study that concluded that Sustiva + Trizivir had no better efficacy than Sustiva + Combivir. While I'm mostly of the mind "if it ain't broke, don't fix it," I'm wondering if a switch from Trizivir to Combivir would more likely than not keep me undetectable while reducing potential long term toxicity (3 drugs instead of 4). Any thoughts? And going further down that road, would entirely switching to a drug that does not have an AZT component further decrease the potential for long-term side effects? In my mind I had hoped to stick with my first regimen for 5 years (just an aribitrary number) in the hopes that something better would replace it then, but now I'm wondering if staying on AZT for another 2 years when other drugs are now available is rather dim-witted. I'll discuss these with my HIV specialist when I see him in 6 weeks, but would greatly appreciate your two cents on these regimen-switching issues to help me focus my questions for my doctor.

Thanks again for all you do.

Response from Dr. Pierone

Hello and thanks for posting.

You are correct in that the comparative study of Trizivir/Sustiva versus Combivir/Sustiva showed no advantage to the 4 drug regimen (Trizivir is a combination of AZT, 3TC, and abacavir) over the 3 drug combination. Since there is no advantage in terms of virologic control it makes sense to simplify to 3 agents. This can be done by changing the Trizivir to Combivir (AZT and 3TC), Epzicom (abacavir and 3TC) or Truvada (tenofovir and FTC). Any of these choices are fine but avoiding long-term exposure to AZT is appealing and a switch to once daily Epzicom or Truvada is reasonable. Good luck to you and let us know how things turn out.



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