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Abacavir and lamivudine are powerful antiretroviral (ARV) medications used to treat human immunodeficiency virus (HIV). Antiretrovirals are drugs that stop a retrovirus, such as HIV, from making more copies of itself. ARVs are usually taken in combination to help control HIV infection, lower the amount of virus in the body, and improve immune system function.
Abacavir and lamivudine belong to a group of ARVs called nucleotide/nucleoside reverse transcriptase inhibitors (NRTIs). In this article, we’ll explain why NRTIs work well for managing HIV infection, when abacavir and lamivudine are prescribed, what their side effects are, and which safety precautions to take when using these drugs.
HIV is managed by combinations of medications that target different stages of the virus’s life cycle. One part that can be blocked is when HIV tries to make the DNA it needs to take over immune cells. This is the step stopped by nucleoside/nucleotide reverse transcriptase inhibitors.
When a person is infected with HIV, the virus enters immune cells in the blood. HIV must be inside an immune cell and produce a special kind of DNA before it can take over the cell and make more copies of itself. During this process, the infected immune cell can die and release new copies of HIV into the bloodstream, which can then infect more immune cells. NRTIs block HIV from making this DNA, so fewer immune cells are destroyed and fewer copies of the virus are made.
Individual NRTIs aren’t used alone to manage HIV infection. The virus is very good at mutating (changing) to survive, so using just one medication eventually leads to drug resistance. If this happens, the medication stops working against the virus. That’s why people living with HIV are prescribed at least two medications. Each drug blocks the virus at a different step in its life cycle. This combination approach is better able to reduce the amount of HIV in the blood and protect immune cells from being destroyed.
Abacavir is a U.S. Food and Drug Administration (FDA)-approved NRTI used to treat HIV infection in adults and children over 3 months of age. It’s prescribed as part of multidrug combinations such as abacavir-lamivudine and abacavir-lamivudine-zidovudine.
Like other NRTIs, abacavir can cause some common side effects, which are usually not severe. These include:
Recent research has found that abacavir may increase the risk of serious cardiovascular issues like heart attack and stroke, even in people who don’t have a history of heart or blood vessel problems. For that reason, this medication isn’t recommended for people who already have heart conditions or a higher risk of cardiovascular disease.
Rarely, NRTIs like abacavir can cause two specific conditions — lactic acidosis (lactic acid buildup in the blood) and steatosis (fatty liver disease). The risk is higher for people who were assigned female at birth and or a diagnosed with obesity, according to the International Association of Providers of AIDS Care. If you’re taking abacavir-containing medications, your healthcare provider will order regular blood tests to check organ function and monitor for these conditions.
Some people have a severe allergic reaction to abacavir. This is called a hypersensitivity reaction. This is rare, but your risk is higher if you have a certain gene variation known as HLA-B*5701, which is most common in white populations, according to StatPearls. Before prescribing abacavir, your healthcare provider will test you for this gene. Testing is required before starting the medication.
If you take abacavir, you’ll need to carry a special “warning card,” provided by your pharmacist. The card lists the symptoms of a hypersensitivity reaction and explains when to seek medical help.
If you have an allergic reaction to abacavir, you must never take it again. Even if you haven’t had an allergic reaction but have missed a dose, tell your healthcare provider before taking the drug again. They will guide you on when and how to restart treatment safely.
Because of the risk of cardiovascular issues, people who have or are at risk of heart disease should avoid abacavir. Due to the risk of liver damage, people with moderate to severe liver problems should not take abacavir. People who’ve tested positive for the HLA-B*5701 gene variation also should not take this medication.
Lamivudine (Epivir) is another NRTI used in combination with other ARVs to treat HIV infection. It was first approved for use by the FDA in 1995.
Commonly reported side effects of lamivudine include:
Like abacavir, lamivudine carries a small risk of liver problems and lactic acidosis. Your healthcare provider will check for these conditions while you’re taking the medication.
People who also have hepatitis B virus (HBV) infection need to take special precautions before starting lamivudine because it’s also used to treat HBV. If lamivudine is taken alone for a long time, the hepatitis B virus can change so the medicine no longer works. To prevent this, lamivudine is usually combined with another drug, like tenofovir.
It’s also important not to stop taking lamivudine unless your healthcare team tells you to, since stopping suddenly can make your HBV infection get worse. People living with both HIV and HBV usually need more than one medication that works against both viruses. Your healthcare team will choose the best combination for your needs.
According to the U.S. Department of Health and Human Services Antiretroviral Therapy guidelines, the recommended treatment for people newly diagnosed with HIV is two NRTIs plus one ARV from a different class. Most people starting HIV treatment today receive a tenofovir-based combination because these are the preferred first choices.
Abacavir and lamivudine are used only as an alternative for people who meet all the following criteria:
Using more than one ARV helps reduce the risk that HIV will become resistant to treatment.
Abacavir and lamivudine are usually considered only if you can’t take tenofovir-based medicines and meet the other safety criteria. Some guidelines suggest the combination works best for people who don’t have a very high amount of virus in their blood, but doctors may weigh other factors too.
Examples of recommended alternative combinations include:
Your healthcare team will choose a combination based on your medical history, lab tests, and other factors. It’s essential to take HIV medication exactly as prescribed. Missing doses gives the virus time to mutate, which can lead to drug resistance and make the treatment stop working.
If you experience side effects or have trouble taking your pills consistently, talk to your healthcare team. Together, you can work on a plan to make it easier to stick to your treatment regimen.
On myHIVteam, the social network for people with HIV and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with HIV.
Have you tried abacavir-lamivudine? What was your experience with this combination treatment? Share your thoughts in a comment below, or start a conversation on your Activities page.
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I have taken this combo with Issentress (rarely given now) more than 20+ years ago. Back then it was the only combo I could tolerate AND did wonders to increase those lonely t-cells. Thank G_d for… read more
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