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regimen change to once daily

Jul 23, 2006

After a year of treatment beginning only 2 years after seroconverting my cd4 count has jumped from a 320 low-point to 650 and my vl dropped from 200,000 to undetectable affter only 6 weeks. My doctor put me on combivir and unboosted reyataz (2X200). However, I have been having adherence problems with my evening dose, causing stress since my work schedule often changes at the last minute (can't get home, remembering to pack pills everywhere just in case, etc). I am also not thrilled about the AZT in my combivir. My Dr. seems a bit reluctant because my labs are so promising and I have virtually no side effects but agrees that my reasons for wanting a once a day morning regimen are valid. He is suggesting: Reyataz, Norvir, Viread and 3TC. I would like your opinion on this regimen. I know that a can be 100% adherent on a once a day morning regimen because in the past year since beginniing meds, I have never missed the AM pills. Thanks and thank you for your work on this website. It's fantastic!

Response from Dr. Pierone

Hello and thanks for posting.

I have patients that report a similar pattern of 100% adherence with morning medications, but occasional misses on the evening pills. This is a situation where a once-a-day regimen may be advantageous. I also have a concern about the use of un-boosted protease inhibitors for HIV treatment. Studies clearly show better responses with boosted PIs and very low rates of development of drug resistance should a boosted-PI regimen fail.

I agree with your doctor's plan, but would consider Truvada (Viread/FTC) instead of Viread and 3TC simply to lower the pill count by one and reduce the co-pay by one as well. Good luck to you!

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