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Considering a switch from Complera to the new single Tivicay option
Jul 31, 2014

I have been hiv positive for a little over five years. Started treatment upon diagnosis originally with Atripla and then switched to Complera. I have been undetectable since starting with pretty good cd4 counts (in the 500 range give or take).

The kidney toxicity and bone loss concerns with tenofovir concern me and I am considering changing to the new Epzicom/Tivicay pill once it's marketed.

I'm 40 years old and have not had a dexa scan nor have I experienced any kidney issues yet but the risk is concerning (they seem to be common issues with others from what I've witnessed-anecdotally).

Is changing appropriate and what issues are you trading?

Response from Dr. Young

Hello and thanks for posting.

First, it's good to learn that you're doing well on your Complera regimen. Maintaining your undetectable viral load and normal CD4 count are key elements in the goal of normal life expectancy with HIV.

Regarding kidney and bone health, while it's reasonable to be mindful that these are the characteristic (if uncommon) side effects of the tenofovir part of your meds, there are also other risk factors that should be factored into an evaluation of health risks (like current health screenings' results, smoking, high blood pressure or low vitamin D levels, just for example). Your right to be concerned about your risks for these problems- they're among the more common complications in the community.

It's also clear that the rates of both of these problems will increase among an aging (and otherwise healthy) population of people. So, while you're not old at age 40, your likelihood of having kidney or bone problems will only increase with your increasing age.

The Epzicom/Tivicay single pill is a combination that is among the elite "recommended" regimens in the current US guidelines, and since it is the only tenofovir-free recommended regimen, a very logical option, especially for those people who have (or have risks of) kidney or bone problems. I've used this regimen quite a bit, and find it (like other recommended regimens) to be very well tolerated and very effective. If you're genetic screen for abacavir (part of Epzicom) allergy is negative, it could be an option for you. The single pill should be FDA approved in the near-term.

Hope that helps, BY



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