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Switching meds - losing an option?
Nov 26, 2006

Love the site...I know you guys hear that all the time but it's true! Question is this - my partner has been on a regimen of Sustiva and Combivir for almost three years now since first diagnosed. Worked brilliantly, CD4 rose steadily from 200 to almost 800 and viral count has been undetectable from the get-go. Think this is partly due to our diligence in making sure he always took every dose. After our last vacation he complained of fatigue, took a month leave from work and after some rest, extra B vitamins and protein shakes to combat possible anemia he felt pretty good again. However, when he next went to his HIV specialist, the doctor immediately suggested dumping the combivir and replacing it with truvada. "The AZT can cause fatigue..." Fine....we went with it. My only concern is that when I first researched HIV drugs three years ago, I remember reading (on your site amongst others) how important that first drug regime was, that it generally posed the best and longest period of health. Now that he's switched after just three years of normally great success I feel like we've cut short that valuable first line of resistance to gain a short term victory over fatigue. Am I worrying for nothing?

Response from Dr. Pierone

Hello, and thanks for posting.

Yes, no need to worry. Changing a regimen for side effects is appropriate and does not lead to drug resistance and limit future treatment options. If your partner wants you go back to being fatigued, AZT will still be available (probably at a lower price as well).

All kidding aside, proper adherence to any regimen, first, second, or salvage is crucial. Poor adherence will increase the risk of viral rebound and drug resistance. It is really the development of multi-drug resistant virus which compromises future treatment options, not simply switching the components of the drug cocktail. There are many people living with HIV infection who have been on continuous antiretroviral therapy for over 10 years. During that time they have made multiple regimen changes driven by the availability of newer, less toxic, and more convenient medications. These patients do not have drug resistant virus and could recycle older medications if the need ever arose.

Hope that this information helps and best of luck!



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