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change of regimen. Dangerous?
Apr 28, 2009

Hello Dr.

I have been on meds since October 2007. I was first on Telzir and Kivexa. after 5 months I was still detectable, but there was no resistance detected. Thus, we switched Kivexa to Truvada and I have been undetectable ever since.

In europe Truvada+Telzir+Norvir is not licensed for once a day use. And I would like to stick to EU guidelines as per my doctor's suggestions. Since I wanted a once a day regimen, my doctor suggested boosted Darunavir+Truvada replacing the telzir. and I have seen the Artimis study which is encouraging.

My question is. If my regimen is working perfectly well as it is, is preferring once a day regimen like the one suggested enough reason to change? or would I waste valuable future treatment options? and what is Darunavir brings me side effects, can I change back?

Thanks a lot for your excellent work and support.

Moe

Response from Dr. Young

Hello Moe and thanks for your post.

The regimen of tenofovir/FTC (Truvada), fosamprenavir (Telzir, we call it Lexiva) and ritonavir (Norvir) is licensed for once-daily use in the US, and listed as an alternative regimen in the current US-DHHS treatment guidelines and recommended by the IAS-USA. As such, this is actually one of the most common first-line regimens that we use in our clinic. The Telzir would be doses 1400 mg (or two tablets) once-daily with 100- or 200 mg ritonavir.

While darunavir (Prezista) is another approved and recommended once-daily PI regimen, I'm generally a believer in ain't broke, don't fix. If your regimen is indeed working "perfectly well", I really would wonder about the incremental benefit to a change. The Artemis study indeed does show excellent results for darunavir and is very supportive of it's use. The issues related to a switch are really minor; darunavir does have a dietary restriction (needs to be taken with food), in contrast to fosamprenavir (no diet restriction). Generally DRV is very well tolerated; but with any switch strategy, you could switch back to your previous regimen if there are any unexpected side effects or toxicity.

I hope this helps. Be well,

BY



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