Abacavir may not work for patients with a lot of experience of other nucleoside drugs - for instance, if you took AZT or double-nukes in the pre-HAART days.
Abacavir has its own 'hypersensitivity reaction' side effect. If you switch to abacavir and get several symptoms from this list: fever, nausea, rash, aches and pains, fatigue: then 1) immediately see a doctor 2) do not stop taking the abacavir before you see the doctor and 3) NEVER restart it once you've stopped.
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The latest licensed arrival among the nukes, tenofovir (Viread) is fairly 'resistance proof', and is probably even better than abacavir; in studies so far, a very low level of fat-related or indeed any side effects have been reported. But because it's expensive some doctors are currently resisting giving it to everyone.
To avoid fat accumulation and raised blood
fat (lipid) levels
Here there is a strong link with the protease inhibitors,
and particularly the drug ritonavir, which these days is mainly used to
'boost' levels of the other PI drugs. Some other drugs like the non-nuke
efavirenz may play a role too.
If you're on a PI-based regime and have never taken a non-nucleoside (NNRTI), ask about changing to NNRTIs.
In studies of switching from PIs to NNRTIs, people who changed to nevirapine, as opposed to efavirenz, had the biggest drop in blood fats. Nevirapine has its own side effects, especially rash, and you have to take half the normal dose in the first few weeks while the body adjusts to it.
Even more effective in terms of lowering lipid levels is the three-nuke option - switching to abacavir (or tenofovir) plus two other NRTIs. 'Triple-nukes' as an option is controversial, though. There's some evidence that immune recovery may be less complete if you take nukes alone. Abacavir and possibly tenofovir are less likely to work if you have ever taken AZT by itself or dual-nuke therapy. Still, some people find triple-nukes a real boost to quality of life.
If you're already on both PIs and NNRTIs, or have failed an NNRTI regime, a new possibility is the
once-a-day PI atazanavir (Zrivada) - the first PI that appears not to raise lipid levels. Two studies just published suggest it's as potent as efavirenz, and that (low-level) resistance
