|stopping meds due to toxicities; a couple questions
May 23, 2001
After meeting with my id doc today,we decided I will stop meds to give my body a break from the toxicities associated with haart: hi-chol,hi-trig, lipodystrophy,plus the other usual culprits. Being on ziagen/epivir/sustiva it is known that you should drop the sustiva some time before the other meds,because of sustiva's long half-lif. Some are dropping the sustiva and adding a pi like viracept to the ziagen/epivir for a week or 2 and some are dropping the sustiva and continuing witht the ziagen/epivir for 5-7days. Can you tell me the pros/cons of each option and what they have done or would do?( vl<50 and a high cd4 and count,968 and 36).And is there any data out there to say if 5 days 6 days or 7 days etc is preferrred? I'd like to avoid the viracept that i've taken before the sustiva, if at all possible. Thanks for your thoughts. Luke
| Response from Dr. Pavia
This is a tough but common question. Here's what we really know. Sustiva has a half life of about 36 hours and low barrier to resistance. This means that low levels of Sustiva by itself can be dangerous. It takes 3 to 5 half lifes for the drug level to fall low enough to not have an effect on selecting resistance. Ziagen requres a long time to develop resistance, therefore leaving it as monotherapy for a while is not likely to case problems. Epivir has a low barrier, but is cleared fairly rapidly.
I know of no studies looking at how to stop this combo. To me it makes sense to stop sustiva while continuing epivir and ziagen for 5-6 days, and I am not convinced the risk is high enough to justify adding viracept. Whether 5, 6, or 7 days is better is anybodies guess. However, this is just my opinion. Cal Cohen has been more of a fan of adding viracept for a few days. Are either of us right? I don't know. Sorry if that doesn't really give you the answer you were looking for, but I think it is better to be honest than sound authoritative.
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