Jan 24, 2009
I am treatment-naive and have no resistance so I have a wide range of options as far as what medications to start on> I will probably be starting soon and, based on a large amount of research that I've done online, I think that Isentress and Truvada would be a good combo for me. I know that Isentress is not yet approved for treatment-naive patients (and likely to be approved for TN sometime in 2009). My question is: Do you consider this a good combo? My VL is 18k and CD4s 400. Thanks for all your help and advice ;)
Response from Dr. Young
Hello and thanks for your post.
The tenofovir/FTC (Truvada) + raltegravir (Isentress) combination has definitely been in the news and looks like it should be an excellent option for first-line treatment. For the moment, it does not have either FDA approval nor treatment guideline recommendations for first-line use. For this reason and the want to (as Obama would say) restore science to it's proper place, I'll adhere to scientific method-- than means that confirmed and published science should be the way that we adjudicate treatment decisions. As such, I'll still most commonly prescribe a efavirenz- or boosted protease inhibitor-based treatment for first line treatment (with 2 NRTIs).
That polemic aside, I share your opinion that there are reasons why RAL-based treatments are exciting-- the STARTMRK study underscores that RAL may address many of the currently unmet needs of efavirenz; namely bedtime dosing, psychological side effects, drug-interactions and improvements in lipid effects. The downside is that the medication requires twice-daily dosing (even when compared to boosted PIs). Nevertheless, doctors and patients alike should look at all options (both approved and perhaps unapproved) to see which treatments best fit an individual's particular circumstances-- then decide on which therapies make the most sense. Sometimes the NNRTI wins, for others the PIs and in some situations already, raltegravir.
I hope this helps. Let us know whtat you and your doctor decide.
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