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Combivir and Viramune Combination - Time for a Switch?
Jun 25, 2006

Dear Dr:

I have been positive since February 2003. My CD4 is 708 and my viral load has been undetectable since December 2003. I have been taking Combivir and Viramune since April 2003 with no problems except some fatigue.

I am concerned about facial lipo and neuropathy from long-term use of these medications. What can you tell me about these medications in those terms?

Also, if they pose problems, what is a good next combination?

I await your response. Thanks!

Response from Dr. Daar

Thank you for your post.

It sounds like you have done fantastic on therapy with excellent viral suppression and high CD4 cells. To answer your question I would need to know whether you are developing facial lipoatrophy and/or neuropathy or are simply concerned about them developing.

If you have developed these problems it is likely that the lipoatrophy is most likely related to the zidovudine (AZT) in combivir. In fact, there is data that some of this will improve if switched to an alternative agent, in particular using abacavir or tenofovir. It is relatively unlikely that any of the medications you are taking would be causing neuropathy.

The fatigue you are experiencing could be from anyone of a number of HIV and non HIV related issues. If you believe it is related to the medications AZT is the most likely culprit; however, this problem usually goes away after a few weeks to months of treatment.

It is important to note that not everyone develops lipoatrophy on AZT. Therefore, if you do not have this problem you should not feel that you need to change. It would be reasonable to just watch carefully on your current very effective regimen with the plan to switch as soon as you note any facial changes.

Best, Eric

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