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Change in my meds regimen - advice
Nov 27, 2012

Ive been on Kaletra and Epzicom for about five years. CD4 averages 325, viral load undetectable, no negative side effects. Ive moved overseas. Whats available here is Kaletra old formula (six gel caps a day, must be kept refrigerated). Closest thing for replacing Epzicom is Combivir (Lamivudine/zidovudine).

Another option is a regimen change to the local health systems standard offering: Truvada and Efavirenze 600 mg (EFV).

Im tempted to go with the latter because it costs less and because of the inconvenience of the old formula Kaletra - - six pills a day and having to keep it refrigerated. I travel internationally frequently and would have to carry my meds with me. The Truvada and EFV regimen would be more suitable for this. However, I dont know enough of the ins and outs of the various medicines to know if making this change would be advisable or not.

BTW: As I write, this, the 24th of November, the 21st anniversary of Freddie Mercury succumbing to AIDS, I realize just how far we have come. Here I am discussing options and convenience factors, when only 20 or 15 years ago, a person with HIV was hard pressed to find any medicine at any price that could keep him alive, let alone healthy and productive.

Response from Dr. Young

Hi and thanks for posting- and recollecting about have far we've come in the past decades.

Paying for medications is getting increasingly difficult for many people. While switching medications should be done with careful thought, if you don't have any previous issues with treatment failure or drug resistance, switching within recommended treatment regimens (for cost, convenience or side effect improvements) can be done without significant risks. Clearly any new regimen poses the possibility of new side effects, but usually this can be managed.

You have summarized your options well, though I'd add to your options, the possibility of unbundling your Epzicom (abacavir and lamivudine) to use the individual generic medications (now available in the US). Switching from Kaletra to efavirenz would be ok (if you don't have any reason for concern about NNRTI resistance). Refrigeration of capsule formulation Kaletra can be problmatic, and it's side effect profile is generally more of a problem than efavirenz's well characterized pattern.

A switch from Epzicom to Truvada would similarly be acceptable, as long as you don't have either kidney or bone disease risks. So, in sum, the Truvada + efavirenz regimen would certainly be a good (and also very highly recommended) regimen.

I hope that helps and be well, BY



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