Doctor, I am treatment naive with a high VL (750K+). My Dr has prescribed Reyataz, Ebzicom, and Isentress. He used Isentress for its fast reduction in VL but then plans to take me off of it. I am concerned with the toxicity of the Nukes and might want to drop one or both and KEEP the Isentress. What do you think of this? Have not started any treatment yet.

This notion of induction-maintenance has been around a long time and there are really very few studies which support its use. Even when the viral load is quite high, traditional regimens work quite well. So the strategy of adding a 4th or 5th drug is overly aggressive and unnecessary.

Epzicom contains abacavir (Ziagen) and the risk of hypersensitivity reaction relegates this agent to second line behind Truvada. Unboosted Reyataz is an ok agent, but adding 100mg of Norvir significantly increases its potency and lowers the chance of developing resistance. Isentress is an excellent addition to the roster of HIV medications, but we have very little data thus far in treatment nave patients. I would consider using it first line in a very select situations (in a patient I wish to avoid nukes and protease inhibitors altogether), but again, not as part of this questionable induction-maintenance scheme.

Good luck!