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Alternatives to Genotype Prescribed Truvada, Rayataz, and Norvir
Oct 15, 2009

My physician did a genotype on me for resistance to HAART meds, finding that Sustiva would not be tenable as part of my regimen. Instead my doctor put me on Truvada, Reyataz, and Norvir. I am extremely reluctant to take any of them due to lipodystrophy. I am afraid because of these side-effects may possibly be irreversible. I am not the least bit happy to learn that Truvada may result in a "buffalo hump".

Can you please suggest other medications for a possible regimen?

Response from Dr. McGowan

Thanks for your question. This is a common concern due to the way that medication labels are written in the US. Truvada is part of a class of medications called NRTIs (nucleoside analog reverse transcriptase inhibitors). There are 8 medicines and 5 combination tablets that contain medications from this class. Some of the medicines in this group...most commonly zerit (stavudine), Videx (didanosine), Hivid (zalcitabine) and Retrovir (zidovudine) were likley to cause changes in body fat (mostly loss of fat from under the skin in the arms, legs and face) called "lipodystrophy". Newer medicines in this class, such as Viread (tenofovir, which is part of Truvada)and Ziagen (abacavir) are much less likley (if at all) to cause these fat changes. But since thay are all in the same family the package information has to list these effects for all of them and doesn't make the distinction above.

The first choice of a medication combo has to be to find one to which your virus is susceptible, then amongst the active meds to pick a combo that is safest. Your doctor has recommended a combo that has generally been very safe and unlikley to cause the fat changes that concern you.

Without the results of the resistance test I cannot suggest any other combo, but you should talk to your doctor about your concerns.

Best, Joe



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