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Choosing Your MedsChoosing Your Meds
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Apr 18, 2001

I have been HIV positive for at least 8 years and thank God, have not been sick with any AIDS-realted illness. Last September I had a very high viral load and a T cell count of 58. I started therapy - Ritinavor, Crixivan, AZT and 3TC. 7 tablets morning, 7 evening. I simply could not tolerate the Ritonavir and after three weeks went on Crixivan, AZT and 3tc - three doses daily, 14 tablets a day. I must confess. I had skipped doses due to the srtict regime but my T-cells went up to 280 and mt viral load became undetectable. I am afraid I would not be able to keep to this strict regime as I still vomit at least once/ twice a week due to food restrictions and skip a dose say one once a week. Keeping the time is also difficult with my busy schedule. I am thinking of changing my regime so I can adhere more strictly to the system - trizivir, one table in the morning and another 12 hours later. Is my information correct? Can i just have two tablets a day as opposed to 14 three times a day? Please help. It would be a miravle from the above if I could start trivizir on its own! Thanks for your help!

Response from Dr. Boyle

Trizivir is a combiantion of Retrovir (zidovudine), Epivir (lamivudine) and Ziagen (abacavir). It is one pill twice daily. Preliminary data indicate that Trizivir is not as potent as three drug combinations that include a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor, especially in patients with high viral loads. However, one open-label study recently found Trizivir to be roughly equivalent to a triple therapy regimen that included Crixivan as the protease inhibitor, largely, it appeared, because of better adherence to the Trizivir regimen. Given your "very high viral load" and low CD4+ cell count, I would be reluctant to use Trizivir alone, but I would consider using it in combination with a non-nucleoside. For example, a regimen of Sustiva (efavirenz) and Trizivir would be a total of 5 pills a day, with 1 in the morning and 4 at bedtime. With your admitted nonadherence, you should discuss changing medications with your doctor ASAP. You are at very high-risk for failing your current regimen, and that may impact your chance of success with future regimens. BB

changing treatment
Medication change

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