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Truvada versus Epzicom?
Dec 29, 2004

Diagnosed in 2002, I have been getting labs done, every 6 mos. & monitoring CD4 & Viral Load, holding on meds. Per my Dr's advise. My CD4 fell from 400 to 48 between my previous labs and current, and corresponding Viral Load of 230,000 fell to 30,000. We did another CD4 test to see if there was something up with the dramatic drop that turned out to give me a CD4 of 120. I was put on Bactrum and told that meds were going to be needed. I had done quite a bit of research myself on initial regimens, and had thought that the following might work well: Sustiva (Efavirenz) + Truvada (tenofovir DF + emtricitabine) - I like that the (tenofovir DF) is a Nucleotide analogue that bypasses phosphorylation, given that it is already chemically activated - possibly saving my body from having to do more work. I also felt emtricitabine, A fluorinated analog of lamivudine with a long intracellular half-life allowing for once daily dosing would be a good option helping to simplify the regimen - 2 pills/day. Well - the Dr. said something about tenofovir + emtricitabine causing a similar mutation, and it would be better to hit the virus from 3 different angles ... I don't quite understand what he meant, and he seemed to move on quickly and recommended Sustiva + Epzicom (abacavir sulfate and lamivudine) I was leery about the stated 7% of people who can have severe allergy to the abacavir - He said it is easy to diagnose, and meds would be switched if any allergy symptoms occurred. I guess I'm wanting to better understand the mutation issue on the previous mix, and get a second opinion about the Sustiva/Epzicom treatment.

Thanks - 26MaleInOhio

Response from Dr. Henry

There is no good data comparing Epzicom versus Truvada with Sustiva for initial treatment. The ACTG has a new treatment naive trial opening soon looking a 4 different once a day treatments than will include a Truvada versus Epzicom comparison (if interested contact your closest ACTG site). I can't offer any comparison of Epzicom versus Truvada with little data available. I use alot of abacavir but often separately (not in a combination pill) so that I can sort out any possible hypersensitivty reactions. My own preference for initial treatment is to start with a boosted-PI and then switch to something simpler if things are going well (after viral load is less than the detection limit). KH

Sustiva dizziness
HIV and blood clots as a side effect.

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