Is It Finally Time to Leave Trizivir Behind? (Editor's Pick)

Question

Hi! thank you in advance! Positive about 25 years, diagnosed 20 years ago, I had started on Combivir alone at one point and remained undetectable early on for a few years. My Doc at the time suggested a break when treatment started to fail as my VL was so low and TCells stable and had wicked reactions to combinations no longer ever advised, DDI, DDT, Viramune (he thought I was a slow progressor anyway). I went on for a good many years without treatment then when the T cells eventually dropped. Tried a bunch of regimens including Reyataz and Sustiva separately and again terrible reactions. Since I had tolerated NRTIs previously I suggested to my (different) Doc Trizivir alone. So I've been undetectable for 10 years plus on Trizivir. All's good but low Vit D, and sometimes I wonder if this many years on AZT isn't causing muscle damage so I consider changing but am scared I'll be prescribed something way too strong like last times. I think some people probably do fine on less drugs it would perhaps be considered malpractice to try but I've done great on a regimen no one would recommend today.Where do I go from here? I believe dont fix what isn't broke but also it's been so long treatments have advanced. I just seem to really react strongly and would prefer another ill-advised regimen that is too light for most then the heavy duty arsenal...open to any suggestions thank you!

Answer

Hello and thanks for posting.

It's great that you're tolerating medications, and have done so for so long. Trizivir was once a frequently used medication, but fell from grace with the appreciation that for most people, it was less potent than other medications. AZT is the main culprit in the regimen- and it's associated with both short- and longer-term side effects. Of the long term effects, lipodystrophy would likely be the most troubling.

One simple way to update and simultaneously simplify your treatment is to consider switching from Trizivir to Triumeq- the newer Triumeq has the same abacavir and lamidvudine you've been taking successfully for so long, but replaces AZT with the integrase inhibitor dolutegravir. You'd be going from a 1 pill twice-daily regimen to a 1 pill, once-daily regimen. Integrase inhibitors are vastly better than AZT as a part of treatment, and Triumeq is one of 5 treatments recommended by 2015 US treatment guidelines. There are many patients in our clinic taking Triumeq- the results have been excellent- scant side effects or toxicity.

Hope that helps, BY