How acceptable and prevalent is the combination Epzicom and Reyataz without Norvir? I am currently taking all three. My virus is non-detectable and has been for several years. How does one know if the Norvir is necessary? My doctor is quite conservative and not very willing to change regimens. Side affects and the expense of the med are my concerns. Thanks.


Hello and thank you for posting.

First off, I tend to continue successful treatments in my patients unless there's a compelling reason to switch. When switching, therefore, I'm looking to assess the risks and benefits to the individual for the change. The potential benefit of switches could be lower risk of side effects, improved adherence (fewer pills, fewer doses) or lower cost.

The regimen that you're taking, abacavir/3TC (EPZICOM, KIVEXA) with ritonavir (NORVIR)-boosted atazanavir (REYATAZ) combines one of our countries alternate NRTI combos with a preferred PI combo. To that extent, you're on a well-established regimen.

While atazanavir cannot be used without ritonavir with tenofovir (VIREAD, TRUVADA) -containing regimens because of drug interactions, 'taz can be used unboosted with abacavir. This was the very subject of the large ARIES clinical trial,
the results of which have been published and suggest in your case that stopping ritonavir (with a adjustment in the 'taz dose to 400 mg once-daily) has no negative impact on the overall medication performance. [Disclosure: I was one of the senior authors on this study, which was sponsored by the makers of Epzicom, Viiv Healthcare/GSK] This study gives credence to the notion of your treatment simplification; it would be worth discussing the option with your doctor, since side effects and costs are of importance to you.

One last thing, since you mentioned cost. Manufacturers of all of three of your current medications offer patient assistance- and copayment assistance programs. These could decrease your out-of-pocket expenses. Check out the Epzicom Patient Savings Plan , the Abbott Rx Assist (for NORVIR) or the BMS Access Virology Patient Assistance Program (REYATAZ) for more information.

Hope that's helpful, BY