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anything new on Raltegravir?
Jan 19, 2009

Over the past 1 year my cd4% has been declining, althouhg my cd4 count has remained fairly high. Because I have been having more frequent allergy and skin problems my hiv specialist here in Columbus, Ohio recently told me that if my next labs in April 09 show more of a cd4% decline then we will consider that a trend and initiate tretment for the first time. It seems like most people are starting out on Atripla. But I recently read that Raltegravir has a more favorable side effect profile than Atripla. And since I am already on Simvastatin for high cholesterol I am wondering if you have any idea how long it will be before Raltegravir becomes a first-line treatment? Thank you

Response from Dr. Young

Hello and thank you for your post.

You're correct in that Atripla is one of the most commonly used first-line medication regimens for HIV. The medication is terrific for many, but not for all. For such patients, we are fortunate to have many excellent alternatives (in our practice, the alternatives tend to get used more than Atripla, but that's a matter of individual choice).

Raltegravir (Isentress) is the first of the HIV integrase inhibitors- it has been shown to have excellent responses when combined with other HIV meds for drug-resistant patients and recent data from the STARTMRK clinical trial have shown exemplary results for first-line use. The study showed that in comparison to efavirenz (part of Atripla), RAL patients had fewer side effects and better lipids, all the while achieving undetectable viral loads faster.

Raltegravir is not FDA approved (yet) for first-line treatment; though this does not mean that doctors cannot prescribe raltegravir this way. I'd expect the drug to get both FDA-approval and treatment guideline listing for first-line treatment this calendar year.

Be well, BY



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