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Trizivir at the get-go
Aug 8, 2004

Hello, My doctor and I took a gamble on Trizivir as a first line therapy. I started with 450k viral load and 290 CD4 cells. We knew data suggested that Trizivir may not work with treatment-naive patients with VL >100k, but the ease of treatment was an important factor in our decision.

I'm now over a year into treatment with Trizivir, and I have a CD4 count of 700 and a non-detectable viral load. Am I a treatment outlier? or was the outcome data about naive treatment with Trizivir premature? How long can I expect to remain non-detectable, do you think?

Response from Dr. Young

Thank you for your interesting question.

I don't think that there is a pat answer to your query. It's clear in looking at patients staring on treatment that triple nucleoside regimens appear to be inferior to two class treatments. You're certainly an outlyer from the standpoint that your viral load has remained undetectable, especially considering the high viral load that you started with.

It's likely that you'll do well for quite a while on your Trizivir alone treatment and I'm generally a suscriber of the "ain't-broke-don't-fix" philosophy. That said, it's also fair for you to be aware (as you appear to be) that other simple (even once-daily) regimens appear to outperform Trizivir alone, even for those who have achieved undetectable viral loads.

In the end, it's a bit of a second philosophical question-- would your rather be proactive (switch to a different regimen or add another drug to your existing regimen) and shoot for improved long term suppression, or sit tight and continue to monitor your labs closely.

Since the ease of treatment was a factor in your initial decision, it might be worthwhile that you consider the new fixed dose combination of abacavir/3TC (2 components of your Trizivir, called EPZICOM) that can be taken once daily. Epzicom in combination with other medications (like efavirenz or newer protease inhibitors) can offer very low pill count (as low as 2 a day), once-daily options. It's conceivable to me that the convenience of these three drug, two class combos might rival or exceed the convenience of Trizivir alone.

I understant that this is not a concrete answer, but there aren't any at this time; I do hope that this helps your decision making.

Thanks for reading. BY



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