Which nukes: Truvada or Kivexa?
Both Truvada and Kivexa are once-daily tablets that combine two nukes in one pill. They each have benefits and disadvantages.
- Truvada = tenofovir + FTC
- Kivexa = abacavir + 3TC
- Neither tenofovir nor abacavir are linked to lipoatrophy, neuropathy or anaemia.
- Abacavir is not recommended in people with a high risk of heart disease and should be used with caution if viral load before treatment is above 100,000 copies/mL.
- 3TC and FTC are very similar drugs. They are interchangeable if individual nukes are prescribed separatelyrather than as a combined pill.
Tenofovir is cleared from your body by the kidneys, and monitoring for kidney toxicity, and not using tenofovir with other drugs that are cleared the same way, are important safety cautions.
Tenofovir can cause a small reduction in bone mineral density during the first six months, but does not seem to increase any risk of bone disease with longer use.
Abacavir is not recommended in people with a high risk of heart disease because some studies have shown that it increased this risk. It is also not recommended when viral load is above 100,000 copies/mL.
The other main side effect linked to abacavir is a hypersensitivity reaction.
However, a genetic test, called HLA-B*5701, is now used in the UK that reduces this risk. A negative result does not guarantee that you will not get this reaction, but makes it much less likely.
Hypersensitivity symptoms include fever, rash, headache, sore throat, diarrhoea, abdominal pain, tiredness, nausea, vomiting, flu-like aches etc that get progressively worse each day.
Anyone who gets these symptoms must seek urgent medical advice with a view to stopping the abacavir.
Once stopped, abacavir must not be used by that person again, as a worse reaction can return that is potentially fatal.