Question
Can my partner in the UK switch from Triomune?
30 September 2011. Related: All topics, Changing treatment.
My partner has been taking Triomune-30 since Jan 2011 after a CD4 count of 135.
After additional tests in the UK and a CD4 count of 153 and viral load of 133, the doctor wants to recommend a new drug because they said the UK doesnt prescribe stavudine.
Is it ok to change meds and what are the likely effects of that? Also do u know what the medication is likely to be?
Answer
Hi
Your partner is getting good advice from this doctor. Stavudine (also called d4T) has not been widely used in the UK for well over five years becasue of the increased risk of a range of side effects.
If everything else is going well, the easiest option would be to continue taking nevirapine (one of the other drugs in Triomune).
The new drugs would then be either Truvada (tenofovir+FTC) or Kivexa (abacavir/3TC), each of which only requires one pill once-daily. Which one of these will depend on your partners treatment history and the result of other tests.
Several other options are available including using efavirenz but the first options above will probably be discussed first.
Your partner always need to be taking a combination with three drugs. With only two drugs, especially just with nevirapine and lamivudine, the combination would not be strong enough. The viral load would be likely to rebound quickly and your partner would develop drug resistance,
There are several options. Please discuss these with the doctor in the UK.
The easiest option is to be treated on the basis of UK guidelines, especially if your partner only has short periods travelling. Most clinics prescribed 3-4 months meds each time and so travelling with enough medication to cover the trip would be ok. This might mean choosing tenofovir rather than abacavir as the third drug, Tenofovir is increasingly available in countries in African.
A second option is to be treated as option one, but to know other meds to use in an emergency. This might involve switching the tenofovir to AZT, and continuing on nevirapine and lamivudine.
The range of generic medications available in Africa might mean that both these combinations are available in Fixed Dose Combinations (in the same pill).
i-Base advocates are not healthcare workers so these are discussions to have with your doctor, but both should be ok.
Thanks for the response. Can my partner then continue taking lamivudine as well with the nevirapine and drop the stavudine?
I ask this because my partner lives in Africa sometimes and they are hesitant to start changing meds (to Truvada or Kivexa) that may or may not be available in Africa in case they have to refill the prescription.
What do you suggest they do?