Question
Why have I been advised to change my combination?
1 December 2008. Related: All topics, Changing treatment.
Why have I been advised to change from indinavir/combivir after 12 years without any problems? My CD4 is 500 plus and I have been undetectable all this time?
Answer
It is strange that your doctor didn’t have a discussion with you about the advantages of changing treatment, but we often hear of similar situations where treatment is changed without this support.
The best thing is to go back and ask your doctor this. Your combination is rarely used now because of side effects and adherence problems. If you are not using ritonavir to boost indinavir levels, then you will be taking indinavir 3 times a day. This is shocking to hear, as this practice stopped in most countries 5-8 years ago. Even if you are using ritonavir to boost the indinavir, more recently approved protease inhibitors are likely to be better for you in the long run. The reason to change the AZT in Combivir is mainly related to the risk of fat loss.
I know that people are anxious to change anything as long as they are happy with the results.
The science in the field of HIV/AIDS is developing very quickly and there are much more data collected and way more is known than 12 years ago. Hence some recommendations that were current then are not any more.
In the case of your combination, even if it has worked perfectly OK for you, it is already known that there are better options now, as well as it leads to serious side effects in the long run, i.e. lipodystrophy, anaemia, possible blood disorders, loss of hair, etc. You can avoid those and increase your quality of life by simply switching. There is more information about the side effects in the i-Base booklet Avoiding and managing side effects.
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