Other nukes
AZT and Combivir
AZT is a twice-daily nuke that has been widely prescribed and studied, but is now used less often in first-line treatment.
It used to be widely used during pregnancy. However. this is now thought less important as there are other drugs.
Combivir is a fixed-dose combination of AZT and 3TC that is taken twice-daily.
The disadvantages of AZT are the side effects of anaemia, fatigue and lipoatrophy (fat loss). Lipoatrophy does not usually occur during the first six months of AZT treatment.
ddI
ddI is rarely used as a first-line choice, because is less effective and less convenient. It needs to be taken on an empty stomach (ie two hours after food). ddI is mainly used in people with drug resistance.
Triple nuke combinations
Triple-nuke combinations are not recommended as first-line treatment as they are less effective.
The main reason to use a triple-nuke combination is to reduce side effects related to PIs or NNRTIs or if there are interactions between these drugs and other medications (ie for TB).
Nukes that don’t mix
Although one nuke can often be switched for another.
The table below shows some combinations that should never be used.
| AZT and d4T | At any time |
|---|---|
| FTC and 3TC | At any time |
| ddI and tenofovir | Especially with an NNRTI |
| abacavir and tenofovir | In a 3 drug combo until an interaction is explained |
| d4T and ddI | Never during pregnancy |
| Triple-nuke combinations | Only two combinations – AZT + 3TC + abacavir or AZT + 3TC + tenofovir – can be used. Others have a high risk of failure |