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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
          
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afraid to switch due to side effects
Apr 6, 2003

Dr,please if i could give a little history.I started treatment successfully with combivir and crixivan for two years.Because of the fear of protease side effects I asked my doctor if I could switch to trizivir alone.I did this for two years until the present and in these four years i have been undetectable with t cells of 550.Now she has suggested I add another drug because of recent study showing trizivir weakness.I am unsure if I should add sustiva or save this drug for a later time.If i did add sustiva could I combine it with combivir or is it possible I could be resistant to epivir without knowing it since I went fom combivir to trizivir.She also has suggested possibly trizivir with viread .Is this too many NRTIs(mitochondrial toxicity)? Has USPHS recommended this as good treatment.Also I have read about a combination of sustiva,epivir,and viread.I am a very compliant patient who would like to control my virus the best I can with the least toxicity and in the right order as to leave the most options for the future.I have been very luck so far as to not suffering any side effects. My worry about sustiva is it being one mutation away from class loss and thats why I'm wondering if its better to hold it for later.But I'm also afraid of trizivir and viread being all in the same class and not as well proven as sustiva and combivir.Is it safe to go back to combivir after being on trizivir.My concern is switching to combivir/sustiva and finding I'm resistant to the epivir and don't know it and then loose the sustiva too because of it.I also wonder if remaining on the trizivir alone is an option until I see a blip in the labs or is this already the begining of resistance and not a good idea.I have an appointment with my doctor next week to discuss thisissue but would appreciate a little insight before the visit. thank you so much for your time.

Response from Dr. Henry

The study your doc is probably referring to is ACTG 5095 which showed that Trizivir was modestly less effective than Combivir or Trizivir + Sustiva for initial therapy of HIV infection at an average time of 32 weeks. That study does not address what to do in persons like yourself who are doing well on Trizivir fully suppressed. It may be reasonable to continue the Trizivir which is a simple class sparing and fairly non-toxic regimen. One could also add something like tenofovir if there is discomfort with just the Trizivir and a priority is given to a class sparing approach to preserve future treatment options. KH



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