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Viread, Lamivudine, Stocrin med combo concern
May 2, 2009

I was recently diagnosed HIV+ after a bout of shingles. CD4 447, viral log 5.92. Age 42 (everyone thinks I'm 35), 160 lbs and gaining weight since treatment started end of February 2009. I have been put on a daily dose of three medications that I've religiously been taking every evening with minor side effects (mostly just headache and some fatigue) as follows: Stocrin 600mg, Lamivudine 300mg & Viread 300mg.

I just read that Lamivudine and Viread combinations have a high failure rate and should not be combined. I am getting medical advice at Bumrungrad Hospital in Bangkok, as I work overseas as an environmental lawyer and live in Laos (I have always had good treatment at this hospital). Have I been prescribed the wrong medicine? I'm new to this, and the literature is a bit confusing. A second opinion would be most appreciated.

Other factors: I just quit smoking, and drink socially (I used to drink a lot, because I'm Scottish, Irish, German decent and my genes are geared that way)

P.S. I graduated from University of Colorado in 89.

Response from Dr. Young

Hello and thanks for your post from Cambodia.

I'm not sure where you're getting your information, but your source is mistaken.

The combination of lamivudine (3TC), tenofovir (TDF,Viread) and efavirenz (EFV, Stocrin, Sustiva) are among the best tested and widely recommended first-line regimens around the world. Indeed, this regimen was used in Gilead 903 clinical trial; a seminal study that demonstrated the effectiveness and safety of the regimen. There's no data to date that I'm aware of that shows any significant racial or ethnic differences in the performance of this regimen; indeed, most of the study results are generated among persons of European ancestry.

Further, if one substitutes emtricitabine (FTC, Emtriva) for the very similar 3TC, the resulting regimen are the components of the often discussed (on these pages) Atripla. Additional information about this regimen was revealed in the

Gilead 934 clinical trial.

Taken as a whole, rather than suggesting that 3TC, TDF and EFV should not be combined, the evidence-based medical science and current

US Treatment Guidelines support their combined use.

I hope this is helpful; don't hesitate to write back anytime. Go Buffs.

BY (CU-Boulder 1990, CU-Health Sciences Cener 1992)



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