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Too Many Docs-Med Change
Sep 2, 2007
60 yo male. 18 years positive. Currently taking Reyataz+Combivir. Undetectable VL and CD4s 1400. Plus Lantus, Zetia and Tricor.
Very early and prior use of d4T, DDI, DDC, Invirase/Fortovase.
AZT always part of treatment protocols.
Want to ditch AZT. Weight loss and facial changes. (Some attribute to old age.) Too may docs and no agreement on change.
Am frustrated and need a new strategy. Suggestions, please.
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Response from Dr. Daar
Thank you for your post.
You ask a great question and I am not surprised that you have gotten different opinions. It is difficult for me to weigh in on this without more information regarding how long you were on previous regimens, whether your viral load was detectable on them, and if you have had previous drug resistance testing.
In general you are correct that some of the changes you are experiencing may be related to age, HIV and/or the medications. If you are truely losing weight then you should be thoroughly evaluated to make sure that you are taking in sufficient calories and not experiencing any undiagnosed infections or other conditions. If after consultation with your providers it is felt that you are primarily experiencing "lipoatrophy" with the loss of fat in your cheeks, arms and/or legs then this should be addressed.
If it is felt that you have lipoatrophy there is some data suggesting that this may be associated with select medications including AZT which is part of combivir. There is also some data showing at least partial reversal may occur when switched away from this drug, in particular to abacavir or tenofovir. The key in considering this option for your problem is to make sure that you are likely to maintain viral suppression if you switch. This would require some level of confidence that you do not have a virus in your body that is resistant to either of these other drugs. While there is a reasonalbe chance that you do not, it is not an assessment I can make with the information available to me. You really need to have a discussion with your expert provider to assess the potential risks of making a change in the context of the possible benefits you may experience from the switch, which is likely to be variable. Unfortunately, there are always some risks associated with changing from a suppressive regimen.
I am sorry I can't provide you a definitive answer, but these issues are complicated.
Best,
Eric
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