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Need for ritonovir-booster for Reyataz with Truvada in treatment-naive person?
Feb 27, 2006

I'm concerned about my MD's starting me on a combination of once-daily Truvada and Reyataz 400 mg without a ritonovir booster, given the reported 21% reduction in Cmax, 25% reduction in AUC, and 40% reduction in Cmin of the atazanavir in the presence of the tenofovir component of Truvada, let alone the higher concentrations of the tenofovir itself in the presence of atazanavir. He says that I don't need the booster because I'm treatment-naive. Do you support this, given the higher 400 mg dose of Reyataz? I'm especially concerned about drug resistance to the PIs, because I already have the K103N mutation, precluding use of NNRTIs. I've noted a clinical study comparing boosted atazanavir vs. boosted fos-amprenavir with the Truvada combination in treatment-naive patients. Though it's only one set of values in time, my last CD4 count was roughly 280 and VL roughly 5000-6000. I have the meds in hand but hesitate to start them for this reason. Thanks for your help!

Response from Dr. Young

Thanks for your post.

I'm in complete agreement with you. First off, I do agree with starting on medications with your CD4 count below 300.

If you were my patient (or someone coming for a second opinion), I would not recommend Truvada with unboosted atazanavir (Reyataz) for all the reasons that you've cited. Moreover, it's not recommended unboosted by the manufacturer either (in this combination).

The stakes are all the more serioius, given your transmitted NNRTI resistance and the inherited lack of treatment options-- this means that getting this round of treatment right is really important, because the last thing that you want is to knock out another class of drugs.

So, talk to your doctor about these topics (again, I suppose)-- I'd recommend either adding ritonavir (Norvir) to the 'taz and Truvada or change Truvada to Epzicome (abacavir/3TC) to avoid the negative drug-drug interaction.

Best health, BY



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