I was diagnosed 4 years ago. The first two years I only took Trizivir. Became VL undetectable in good time. My CD4's have only made it to around 270 from about 130 initially. These last two years I have been taking the Trizivir plus Sustiva, so basically I am still on my "initial" regimen plus an extra drug (sustiva). I'm doing OK though. Still undetectable VL and CD4's not great but hangin' in there at around 270 and hopefully with go up. I just read a study (from Italy ?) that said people taking a 3 -med combo are significantly more likely to have treatment failure than those that take a 2-med combo plus Sustiva (in the Infectious Disease Journal, July 1 issue). I just saw my doctor today and asked if I should switch the Trizivir (3-med combo) to a Combivir or Truvada or Epzicom and stay on the Sustiva also. He said no, because then I may have to risk drug resistance issues and "if it's not broken, don't fix it". I haven't had any Lipotrophy in these four years so he says I probably won't have to worry about it since I haven't had those problems. Here is my question. After reading that article, should I insist on a 2-med combo with the Sustiva or just stick with the Trizivir (3-med) with Sustiva? Did that study perhaps not address the 3-med combo WITH Sustiva? I'm confused. I hope you will answer this for me. I have written to this site two other times with questions and never get a response. Please address this. Thank you very much for this site. It is a great source of information.

Thank you for the posting and I am sorry that this is all so confusing. Let me provide some important perspective that you can consider while discussing this issue with your provider.

The study you read showed that people who received three NRTIs, one of which being abacavir, such as the regimen you were on prior to adding efavirenz (sustiva), did not do as well as those on two NRTIs with sustiva. A more definitive study of this was published over a year ago showing unequivocally that while Abacavir/lamivudine (3TC)/zidovudine (AZT) taken as Trizivir worked well, it did not work as well as regimens that included sustiva. It was based upon this that many modified the regimen of those on trizivir, which I suspect may have been the reason for your change a few years ago. The recent study you read is consistent with this.

Soon to be published is the other part of the original study I spoke of which compared two NRTIs (AZT/3TC as combivir) with sustiva to three NRTIs (AZT/3TC/abacavir as trizivir) with sustiva, the regimen you are taking. This study showed no difference in outcomes. Therefore, you need not swith your regimen for fear of increased risk of virologic failure. As your provider suggested, the reason to switch your regimen to 2 NRTIs from 3 NRTIs with sustiva would be more for reducing toxicity or increasing convenience.

Based upon what you have written, that you have been undetectable since starting trizivir and have remained that way on trizivir with sustiva, I personally think you will likely maintain viral suppression on 2 NRTIs with sustiva if this is something you choose to do. That being said, there are no guarantees and I do encourage you to discuss this further with your primary provider so you are aware of all of the risks of changing a regimen that is working.

Best, Eric