Change AZT to Tenofovir after 15 Years?

Question

Dear Dr Benjamim, you are really an angel in My life, I follow you here and you help me a lot when I tested positive in 2002. I'm 52 now and I am from Brazil and have been positive since 2002. I have been taking AZT, lamivudine and efavirenz for almost 15 Years and maintaing an undetectable viral load since the first weeks. My CD4 was in range 500-800. I have no real side effects. At this appointment my consultant asked me to change from AZT to Tenofovir; be easier take only time per day. I understand will money and for governement is better to supply medicines for more people I should change but Please, advice me about the drug and risks. World you think it is sensible to swap to a new regime when my current one is working? Are there any risks to this? Would I be able to swap back? Many thanks for all, I am proud about Giselle Bunchen's sun called Benjamim, God continue to bless you, best regards Raphael

Answer

Hello and thanks for posting from beautiful Brazil, and for your kind words.

I'm in agreement with your doctor. While AZT was a work horse first-line drug for many years, it's been long replaced by other more potent and better tolerated tenofovir in most national and global treatment guidelines.

The proposed regimen of tenofovir, lamivudine and efavirenz is a World Health Organization 2016 recommended regimen- doing this would decrease risks of AZT-related toxicity (including lipodystrophy, headaches and anemia), and convert your regimen to a once-daily treatment (usually, but not necessarily a single pill per day). Tenofovir is uncommonly associated with kidney or bone toxicity- so this should be assessed before, and during treatment.

Certainly, if you should have any unexpected side effects or intolerance of the new medication, you would be able to switch back to your current regimen.

I hope that this is helpful, and feel free to write me back at this Forum. BY