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Truvada Switch
Apr 1, 2012

Hi,

I'm currently on Isentress and Truvada (having just switched from Intelence + Truvada) , however my doctor has told me I may need to switch away from Truvada due to protein being found in my urine. Plus low blood phosphate levels.

Just wondering what potentially this could be replaced with? I can see Kivexa (being from the UK) being a possible, any others? Ideally trying to keep the pill burden down...

Thanks,

Paul

Response from Dr. Young

Hello and thanks for posting from the UK.

Would seem that you've had good monitoring for possible kidney injury from the tenofovir part of Truvada; it's reasonable to entertain getting you off of that medication with the urinary protein and low phosphorous levels (provided that there's no other explanation for the findings).

The most straightforward switch for you would be to substitute abacavir/3TC (Kivexa, we call it Epzicom on this side of the pond). One should have a genetic test, called HLA B5701 prior to switching to make sure that you don't have risks for an allergic reaction to abacavir. This switch shouldn't cause any new side effects and would be expected to maintain viral suppression (as long as you didn't have any prior issues with drug resistance, in which case the switch would need to be done with knowledge of resistance testing results).

Any alternative switch would usually stay within a more limited set of nuke options (and frankly wouldn't be something I'd entertain). Even more unorthodox would be to substitute a different class of medication, such as CCR5 inhibitor or protease inhibitor for the tenofovir- adding complexity to the treatment perhaps, but certainly wading into less well charted scientific waters.

No mater what, the regimen of Kivexa/Isentress is one that we've studied in our research group and is one of the alternative regimens in the most current US treatment guidelines. I think that you're likely going to do well and (fingers crossed) will have improvement in your kidney function.

Be well, BY



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