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Once a day combo
Jul 27, 2003

Doctor current combor viread/viramue/combivir. After many vl blips I decided to change meds. At 1200 vl I had a restance test which came back negative to all meds, no resistance whether is correct or not.

More than 5 years on combivir,3 or viramue,2 or viread.

The doctor is changing meds to rayataz 300/norvir 100,viread, emtrivir.

He is dropping viramue and combivir, good idea or not? what do you thanks J

Response from Dr. Aberg

I assume your doctor is changing your meds due to the recent increase in your viral load. Fortunately, they did not detect any mutations. The regimen of Reyataz (atazanavir, ATV), Viread (tenofovir, TDF) and emtriva (emtricitabine, FTC) is a good combination and is taken once daily. The ATV must be given with a 100 mg dose of norvir (ritonavir, RTV) to boost the level of ATV because there is a drug interaction between ATV and TDF which may reduce the drug lenels of the ATV.

The question is whether is it is right for you. FTC is similar to 3TC except it has a longer half life. If I had to predict resistnace mutations as a reason for your failure, I would have said a M184V which confers resistance to both 3TC and FTC. Although your genotype was "negative", you could still have some virus that does in fact have mutations. After time, there may be more pressure on the virus and these will become detectable on a genotype.

The other issue is that maybe this 1200 was just another blip and in studies, having a blip was not necessarily a bad thing and patients do fine continuing their same medications.

I think the regimen your doctor chose for you should be fine. It should be well tolerated. ATV is associated with an increase of bilirubin and may cause you top appear yellow but it is benign and should not cause you any illness. I would encourage you to have frequent monitoring of your complete blood count, kidney and liver function as we routinely do for all medications.

Good luck on this new regimen

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Taking Kaletra when traveling

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