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Reason to switch to TZV + TFV ?
Mar 20, 2005

Greetings from Spain, I've been on HAART with EFV, EPV, ZDV for 16 months( 0 VL and 500 - 750 CD4 all this time around - - no side effects). However I'm a bit concerned with this treatment because a friend of mine got resistance to all NNRTI's due to a hepatitis A outbreak that made him stop HAART inmediatly. Do you think I may think of switch to trizivir + tenofovir to avoid "any accident" that could happen in my life and make me stop unexpectedly this treatment getting resistance to all NNRTI's? Are there side effects on TZV + TFV on the long term and for how long this treatment has been studied? is this treatment as good as my actual one? THANKS IN ADVANCE FOR YOUR EXTREMELY HELPFUL JOB !!!

Response from Dr. Sherer

No, I see no reason to change your medications when the results you have had to date are excellent. Just maintain your record of excellent adherence, which is the best activity upon which to focus your energies.

The combination of triziir and tenofovir, which is a 4 drug NRTI regimen, is still in clinical trials. Until these are completed, I would not recommend switching to this combination. The 3 drug NRTI combinations, such as DDI + TDF + 3TC, or TDF + CBV, have been very disappointing with high levels of virologic failure, and so should not be used at this time unless another suitable regimen can't be used.

The NNRTIs are vulnerable to resistance, as you suggest, with only one amino acid codon change causing full resistance to the class. Nonetheless, they have been shown to be effective in the majority of patients over three years in clinical trials, with the highest success rates in those patients who maintain the best adherence.

Please note that your viral load is NOT zero; it is best described as below the level of detection for the assay, usually < 50 copies/ml.

Finally, talk to your doctor about these issues. Only he or she has all of the information about your case that a doctor needs to make an informed opinion of your question. That is far superior to this casual consideration of your question, which is likely to be missing some important parts of the story.


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