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Switching from a Long Successful Combo To a simpler one
Jun 4, 2006

I'm interested in simplifying my meds and would appreciate your feedback. I've been HIV+ for 16 years, have never taken monotherapy, started (and still take) AZT+3TC as soon as 3TC hit the market and tried the original Saquinavir for 3 months when it came out (but didn't get good response).

I've now been on an AZT+3TC (Combivir) plus Delavirdine plus Crixivan combo with undetectable VL and CD4 's in the 500-800 range for almost 9 years.

Twenty-three pills a day for HIV, combined with three times a day dosing, and Crixivan's empty stomach requirements seem quite onerous compared to some of the newer drug combos. I've also experienced lipoathropy and increased blood lipid levels.

They say if it ain't broke don't fix it, but a Truvada+Sustiva once a day combo sure looks appealing, especially if dropping the Protease and the AZT might help the bodyfat and lipid issues. The only information I can find seems to approve of this as an initial starting therapy, or disapproves of it as a choice after a failed combo. What would your advice be on switching to simplify in my situation?

Response from Dr. Pierone

Wow, this regimen is certainly a blast from the past. Some clinicians like to see long-term data before prescribing any of these new-fangled drugs for HIV infection. But this tired old lipid raising, fat redistributing dog had its day, and that day surely passed a very long time ago. So changing would be a good thing.

So what to do? You may have some archived resistance from the 1995/96 dual nuke/Invirase time period, but it is unlikely that you have much in the way of resistance to contend with. It is likely that you would do fine with Truvada and Sustiva once a day. Raise this idea with your clinician to get their thoughts. Your change would be considered a switch rather than a failed regimen salvage scenario.

Let us know how things turn out and good luck!



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