|epzicom/sustiva or combivir/sustiva
Aug 2, 2009
Hi Dr. Young! I am 37, have been HIV positive for about 2 years and had continuously drop in cd4 cells, now 345 and my doctor wants me to start treatment. He offers 2 possible treatment epzicom(here kivexa)/sustiva(here stocrin) or combivir/sustiva . I have no other health issues (eg. bad liver or kidneys). My mother has some kind of heart arytmia (supravenikularniexstrasistola) and I am a bit woried if it could affect me in any way, regarding possible side effects from drugs. I do a lot of sport,haven`t had any problems with heart so far, did EKG and was fine. Which of those regimens is better to start? I really can`t decide and your opinion would be very helpful. Thank you very much for all your work here!!!
| Response from Dr. Young
Hello and thank you for your post.
First off, I'd agree that if your willing and able to be adherent to medications, with a CD4 count around 350, it would be best to consider treatment.
Both Epzicom (Kivexa) and Combivir are alternatively-recommended NRTI components to treatment according to US treatment guidelines. There has been much discussion (and IMO, prematurely concluded) about the potential risk of abacavir (part of Epzicom/Kivexa) and heart disease in the DAD study. This has resulted in the downgrading of Epzicom from preferred to alternative. Nevertheless, several recent, well-designed studies have failed to find an association with abacavir and heart disease.
You're mother's arrhythmia (unless caused by a heart attack) is not the kind of heart disease that appears to be related to the observed heart events in the DAD study; hence, I don't think that it becomes entirely relevant to your treatment decision.
So, in your case, if genetic screening for abacavir allergy is available and negative, abacavir/3TC (Epzicom) should very well be a well tolerated, once-daily combination treatment with efavirenz (Stocrin, Sustiva). Combivir, in my opinion is also a viable option, but subject to somewhat greater risk of side effects, and is doses twice, rather than once-daily.
In any event, as our patient community lives better and longer, we'll focus greater attention to the prevention of all sorts of long-term health issues-- heart, kidney, liver, bone, mental health, just to name a few. I'm sure that your doctor will monitor for these issues now and in the future.
I hope this helps, and be well.
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