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Is this an advisable change?
Nov 2, 2004

My partner for 32 years has been HIV positive for 16 years. He has been on a wide variety of antiretrovirals and has developed a resistance to some of them. In early 2003, his viral load was 38,000 and his T cells were 126. He was put on his current cocktail of Kaletra, Ziagen, and Zerit. His viral load is now undetectable and his T cells are 403. However, he wants to get off Zerit because of lipodystrophy. His doctor has given him a prescription for Truvada as a substitute for Zerit. He was never on Viread but was on epivir. He read in the Body's TAGline Vol II, Issue 10 that Ziagen should probably never be used with Truvada due to concerns about resistance and efficacy. He wants to know if he should be taking Ziagen and Truvada together as he already has resistance to most Zerit type drugs. Really anxious, and I am sure theree are many others. Please help.

Response from Dr. Conway

The issue about using Viread with Ziagen is a problem in the setting of a regimen that includes only nucleoside drugs and does not include Retrovir. In such cases, the barrier to resistance is too low to make this a viable regimen. In your partner's case, the presence of Kaletra in the regimen makes it such that this would not be a problem.

The issue of using Truvada rather than just Viread is an interesting one, as the Epivir part of the Truvada may not be needed. In any case, the idea to change here is quite probably a good one, and the type of change being put forward for your partner is quite a safe one indeed, both from the point of view of side effects and resistance.



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