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Combo change/Dosing Questions

Aug 13, 2004

I was diagnosed HIV + last July, with a viral load of 500,000+ and a CD4 count of 7. Unbeleivably, I never developed any OIs. I have had an undetectable viral load since August 2003, and my CD4 count is now just over 200. I have been on Trizivir (1 tablet twice a day) and Sustiva (1 tablet once a day). Recently I have been having nerve problems in my legs. It is not Neuropothy, but is a numbness in my legs that causes dificulty walking - no pain. After seeing several doctors and having an MRI, it was determined that the likley culprit was the AZT in the Trizivir. My doctor switched me to Viread (once daily, with food), Emtriva (once daily) and Ziagen (twice daily). My questions are these: 1) I have been off the Trizivir for 10 days now, with no noticible recovery of the nerve symptoms - is there a time frame that would be considered "average" for noticible recovery? 2) The FDA approved Truvada as a combo of Viread and Emtriva. Is there a standard time frame before this will be available at my local pharmacy? 3) Viread is labled to be taken with food, but I have seen on several web sites that this is not necessary - any thoughts on that? 4) Also on several web sites I have seen that Ziagen can be taken as two tablets once a day as opposed to one tablet twice a day - any thoughts on that?

I am leary of switching to a new drug combo since my last combo has worked so well, but at the same time, I am excited by the "once a day" possibility of the new combo. That is why I am wodering about the food restrictions on Viread and the once vs. twice a day dosing of Ziagen. I have talked with my doctor about these questions, and he is willing to let me try the Viread without food and Ziagen once a day. However, he has no personal experience with these dosings. I am hoping you can give me a second opinion before I change my dosing schedule.

Thanks for a wonderful site!

Response from Dr. Lee

It is good that you have had such a response to the meds. The use of three nucleosides with a non-nucleoside (Sustiva) may not be necessary. Two nucleosides are more commonly used in these combinations. It may be that Viread and Ziagen (which may have similar resistance patterns) is not the best combination. There are certainly better studied dual combinations.

As far as your questions: 1) 10 days is not really enough time to notice a significant recovery. 2) Truvada (Viread and Emtriva) will probably be available by September. 3) Viread is recommended to be taken with food. (In fact most of the meds are best absorbed when taken with food.) 4) Ziagen was approved for once daily treatment a week ago. (And will be available in a combination - Epzicom; one pill, once a day with Epivir also in September.)

Be well.

New "one-a-days"
viramune to sustiva

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