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Switching from Atripla to Reyataz, Norvir and Epzicom
Dec 22, 2011

I've been taking Atripla for several years with no problems. My Dr. has advised me that my Creatine level have increased to much, currently at 1.53. My CD4 count is 690 and CD4 % is 43.1% and me HIV count is less than 20 copies. My Dr. feels this is a good switch, I'm concerned about the Epzicom particularly. Do you feel this is a good switch based on the info I gave you?

Response from Dr. Young

Hello and thanks for posting.

As people living with HIV live longer and older, there's an increasing awareness of long-term health promotion. In this way, keeping kidneys health is certainly an important goal.

It would appear from your post (and rationale behind your question) that your have medication-induced kidney injury. It's always important to make sure that all of the other possible causes (such as high blood pressure or diabetes) have been addressed as well.

If it's the tenofovir part of Atripla that's the key suspect, then switching off of tenofovir makes sense to me. What's less clear is why the other parts of the regimen need switching-- it's not unreasonable to switch if there are issues, for example with efavirenz side effects.

A swap from the tenofovir+FTC to abacavir+3TC (Epzicom) is quite reasonable so long as you're genetically screened by HLA B5071 tests. I'm a little concerned however about the switch to Norvir+Reyataz, since this combination has also been associated with increased risk of kidney injury, albeit less so than tenofovir. I'd ask if an Epzicom + efavirenz (keeping that medication the same as in your current Atripla) regimen or a different Norvir-boosted PI might be appropriate.

Either way, your kidney function (creatinine and urine protein levels) should be monitored closely.

Hope that helps, BY



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