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about to start treatment
#197171 - 06/22/06 08:00 PM
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hi. kinda scared.. about to start treatment. My dr wants to use an induction/maintenance strategy starting with an intense four-drug Kaletra (LPV/r, lopinavir/ritonavir)-based regimen along with Combivir [AZT/3TC] + Viread [tenofovir]. can you tell me side effects with these? also is facial lipotrophy a side effect of this? any help would be geat. thanks
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Survivor
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Legend
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Reged: 10/30/05
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Posts: 3256
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Loc: Get off the fence and live again!
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Is this your first line regimen??? Seems a bit strange they would even talk about AZT/3TC?? If this is your first line regimen why not Sustiva/Truvada or Kaletra/Truvada etc?? Once a day regimin?? What did your Pheno/Genotype come back with? Any resistance with your virus?? Lipo is way down the road, way down the road and hopefully by that time new classes of drugs that are dealing with Lipo will be out there for us...
Eric - "RatBoy"
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ny10001
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Grand Master
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Reged: 07/08/05
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I agree with Eric's comments. It is HIGHLY unusual these days to put someone on an AZT-based regimen such as Combivir. I also don't understand why your doctor wants to put you on Viread as well. Viread is one of the two components in Truvada. Viread is very similar to 3TC which is the other component in Combivir (Combivir is AZT + 3TC) combined into one pill. Truvada is a combo. pill as well and competes head to head with Combivir.
Truvada is virtually side effect free. It only has to be taken once per day. Combivir, on the other hand, has to be taken twice per day, it has been associated with nausea, tendency to reduce energy levels due to the fact that it can trigger anemia, and it has been associated with lipo-atrophy of the face and arms. The lipo atrophy usually starts at the end of the first year (if it's happening to you...some get it and some don't). Kaletra is also associated with some lipo-dystrophy and gastro-intestinal issues...but not nearly as much as the AZT component of Combivir. AZT is a rather toxic medication.
I'm not a medical doctor, but I know if enough to see that unless you have some extenuating resistance patterns, this combo is highly unusual. There's also a potential to not be able to tolerate the regimen all that well.
Are you seeing an HIV specialist or a general practitioner? I would recommend getting a second opinion from an HIV specialist.
These days, typical first regimens often consist of Sustiva/Truvada or something like Reyataz, Norvir, and Truvada.
Of course, if you have inherited a resistance, that may be driving this unusual combination, but I really think a second opinion from a qualified HIV specialist would make sense.
Good luck.
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franfrog
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Now I on the other hand started with combivir only a year ago. I am on combivir and sustiva. I have had no side effects from the combivir, the sustiva got me the first night but other then that my numbers have been great. I had anemia before I started treatment so the ATZ had the reverse effect on me. It seemed to have helped my anemia.
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ny10001
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Perfect example of how everyone reacts slightly differently to the medications. I was only referring to compiled statistics. If you tolerate Combivir well, then there may be no reason for you to switch. AZT in the long run can be a bit toxic, but I'm guessing your doctor is monitoring your liver enzymes on a regular basis. The only other reason to switch to Truvada would be the fact that you can take it once daily instead of twice. But for some, that's not enough of a reason to switch.
I agree that Sustiva takes a little getting used to. I took it for 1.5 years. I was fine until the last few months, then the CNS side effects started getting worse, so I requested a change. Kind of a bummer, though....I was looking forward to the single Sustiva/Truvada pill that's coming out later this year. Now I have to take 4 pills once a day instead of 2.
Oh, well....at least I'm sleeping better now!
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I would agree with the others that this isn't exactly a cutting edge combo. Kaletra and Viread may both give you some stomach issues. Both diarreah and nausea are pretty easy to treat. The AZT in the Combinvir gave me terrible headaches when I first started it, but lot's of BC headache powders and in a few days the headaches when away.
The good thing about AZT, is that while it is rather toxic. It's still the only drug out there that crosses the blood/brain barrier which means it can reduce the chances of HIV related dementia.
Also check with your doctor, but my doctor has always started new drugs staggered (ie; Kaletra first or two, followed by Combivir, etc) working up to the full dose of all. This way if you have side effects, it's easier to pin point which drug is causing the problem./
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Hi Kinda, it is nice to initiate treatment but my worry is why four drugs? In particular combination of 3TC and Tenofovir with issue of resistance as for 3TC single point mutaion is enough, it will decrease the efficacy of Tenofovir. Facial lipoatrophy will not be a problem as d4T is not part of this regimen, as it is the most common agent.
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Hi Kinda, it is nice to initiate treatment but my worry is why four drugs? In particular combination of 3TC and Tenofovir with issue of resistance as for 3TC single point mutaion is enough, it will decrease the efficacy of Tenofovir. Facial lipoatrophy will not be a problem as d4T is not part of this regimen, as it is the most common agent. [avoid four drug treatment regimen so that you can maintain future treatment options and hence HIV specialis.
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Hi Kinda, it is nice to initiate treatment but my worry is why four drugs? In particular combination of 3TC and Tenofovir with issue of resistance as for 3TC single point mutaion is enough, it will decrease the efficacy of Tenofovir. Facial lipoatrophy will not be a problem as d4T is not part of this regimen, as it is the most common agent, and if happen that a year or more after. Avoid four drug treatment regimen so that you can maintain future treatment options and hence consultHIV specialis. I had never had such combination in my clinical practice. Anyhow think again and consult the expert in the area.
I am pharmacist by profession and my name is Wubeante from Ethiopia.
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