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Reyataz/Truvada vs. Reyataz/Combivir

Jan 13, 2005

My partner and I are both about to embark on starting meds. We both were diagnosed as HIV + as of Nov 4, 2004.

His doctor is prescribing Reyataz/Norvir/Combivir. My doctor is presribing Reyataz/Norvir/Truvada. We both have the same resistence to the entire class of NNRTIs.

My question is the Norvir. I understand that it is essential in my regimen where the Tenofivir reduces the potency of the Reyataz that it be boosted with Norvir to counteract that. But why would he need to have Reyataz boosted with Norvir if he is taking Combivir?

And why would I not be presribed the 400 mg/day of Reyataz (300 mg has been prescibed) to overcome the Tenofivir effect on Reyataz, or is that just overkill?

I guess my point is it seems like his regimen will have more potency with the Reyataz than mine will. My viral load is over 750K, so I am concerned with getting the most out of my regimen (his viral load is 69K).

One last question, with his regimen, isn't it odd to prescribe a once a day PI (Reyataz) with a twice a day NNRTI combo (Combivir)? Wouldn't it make more sense to go with with Truvada or Epzicom?

The main reason for my regimen is my request to get on a once a day regimen due to my fear of missing doses on a more complicated regimen.

Response from Dr. Pierone

The best way to use Reyataz is not yet clear. There is no question that this agent represents a significant advance in the protease inhibitor class. It has fewer metabolic side effects, is dosed once a day, and is quite potent when boosted by Norvir.

The main reason that Reyataz is often combined with Norvir is that the addition of this boosting dose of Norvir produces a much more powerful punch. In fact, the AIDS Clinical Trials Group (ACTG) is studying Norvir/Atazanavir only (with no nucleosides at all) for treatment of HIV infection.

I agree that it does not make a lot of sense to pair a once daily medication like Reyataz with a twice daily medication like Combivir. Especially since Combivir has more side effects than Truvada. For someone dead set on using unboosted Reyataz, it probably makes more sense to use it with Epzicom.

In your case with a high viral load it should not be a problem to use Truvada with boosted Reyataz because the Norvir makes up for the reduction in blood levels of Reyataz that the Viread produces. I should point out that there are not yet published data on the combination of Truvada, Norvir, and Reyataz. But in clinical practice (including mine) this regimen has become quite popular and results have been excellent.

High viral load. Should I do something?
just starting meds

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