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Is mararviroc safe?
May 18, 2013

Dear Dr. My son has been HIV+ for many years and has been on almost every regimen. They all caused side effects, so we kept moving on to the newer regimens. His virus was undetectable for many years on the protease inhibitors with truvada. We had to take him off because the diarrhea was so severe, and he has an anal fissure. He has mental issues from being molested causing his hiv. It's a very complicated case. He is taking complera, and he has no diarrhea, and is mental state has improved almost 100 percent, but the viral load has crept up in the past few months. He has always been undetectable in the past. The vl is now 468. We are in desperate need of help because we are running out of options for regimens. His dr. is looking into this selzentry, but if it causes the diarrhea and other severe problems, I would be just as well off to put him back on the protease inhibitors that I know kept the vl undectable. It is such a serious decion when he has improved so much on this complera. It makes me think it is not as strong as the other regimens. His cd4 cells are 600. I don't want to take him off of this complera because this is the first time he has had quality to his life in 19 years, but we are so afraid of resistance. My main question is - if we stay on the complera, could we be causing resistance to other drug families and causing him more harm by leaving him on it. Thanks so much! I am desperate for your opinion.

Response from Dr. Holodniy

In general maraviroc is well tolerated with minimal chance of diarrhea. An HIV tropism test would need to be performed first to determine if he has the right kind of HIV strain that could benefit from maraviroc. I assume his viral load was undetectable on complera and is now detectable, as opposed to never undetectable with complera. If the latter, there is more possibility of resistance. His viral load is still quite low and that makes it difficult to have a HIV resistance test done, in order to see whether his virus is now resistant to any of the drugs in complera. Usually laboratories need a viral load of > 1000 to perform resistance testing



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