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Treatment options
Aug 30, 2013

I'm currently on PI monotherapy and doing well. I have this regimen for a year now. I started with Atripla but developed a rash after 2 weeks and was withdrawn. My second regimen was Truvada, Reyataz and Norvir but I needed to stop due to kidney toxicity. Next option was Epzicom but I'm positive for the genetic mutation that increases the odds of an allergic reaction to the Ziagen. Now as far as this therapy works everything is fine but my concerns are a failure. I'm 100% adherent and I never missed a dose. If this therapy would stop working what other options are available? I don't have any resistance issues. My doc mentioned Combivir but I'm afraid of the AZT and its link to lipoatrophy. What drugs would you consider? Thanks for your advice.

Response from Mr. Vergel

I am not sure what country you live in. I will assume it is the United States, Canada, Australia or Western Europe.

There are several drugs regimens that can be constructed without tenofovir (main culprit in kidney issues)or a non-nucleoside analog or abacavir (main culprits in rash).

Using protease inhibitor monotherapy (with Norvir boosting) without a nucleoside backbone has been explored in the past with mixed results when it comes to long term efficacy. For some people who achieve undetectable HIV viral load on common regimens but then switch to boosted PI monotherapy, the outcome may be more promising. But there is always that fear of eventual resistance and drug failure.

These are some of the potential regimens that have been studied in small studies:



raltegravir+Kaletra (I do not like the increases in lipids)

A third drug that can be explored in combinations with the above regimens is Maraviroc. You virus would have to be R5 tropic for the drug to work (this requires a special tropism test and for you to have some viral load to measure it).

Talk to your doctor about your concerns and review the data of these and other studies with him or her.

Let us know what is the outcome of your discussions with your primary care physician.

No HIV Meds equals Death and I dont want to Die

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