Question:

I have been on a combination therapy of Kaletra and Truvada for 2 years with good results. An undetectable viral load, Cd4 count has gone from 40 to 269, and [I have] tolerable side effects. This month my Dr. has switched me from Truvada to Combivir due to a slightly decreased kidney function (Glom Filtration Rate, 49.7). Dr. feels strongly that the Tenofovir in Truvada is causing this.I have experienced serious negative reaction to Abacavir (Dr.'s first choice switch to ) justifying the change to Combivir. I have two questions...

Is the Kidney test in question an accurate gauge to justify a radical change in meds at this time?

I am experiencing severe Nausea, body aches and severe weakness with Combivir after just 2 weeks of use. I am also concerned with the long-term side effects (fat loss, etc) caused by the AZT in Combivir. Are there other combinations that I should consider trying and discussing with my Dr., that could offer better quality of life than I am experiencing with Combivir? My Dr. hasn't discussed any other options with me.

Answer provided by:

Ross Slotten, M.D.
Klein and Slotten Medical Associates
Private Practice in Family Medicine
With a special interest in HIV disease

I understand why your doctor is concerned about your kidney function, since your GFR (or glomerular filtration rate, a gauge of kidney function) is slightly abnormal, and tenofovir (Viread) can rarely adversely affect kidney function. If this was a single reading, it might be helpful to repeat the test. Occasionally there can be dips in kidney function with a return to normal on the next reading. There are also other tests of kidney function, such as measurement of the amount of protein your kidney puts out in a 24 hour period. If your kidney function remains abnormal, or a 24-hour urine protein analysis is abnormal, you may have no choice but to change your regimen.

I share your concern about the long term effects of AZT. I try to avoid using AZT or Zerit these days because of the risk of lipodystrophy; however, sometimes we get stuck--untreated HIV is invariably fatal. You do have options, such as combining Kaletra with Sustiva, though that combination may cause significant elevations in your cholesterol. I would meet with your doctor again and discuss all possible alternatives with him or her.

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