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Switching medications
May 2, 2009

Hi, Im currently on Truvada (1 a day) and Raltegravir (2 a day) and im finding it difficuilt to maintaine the regime due to my work schedule. I have been placed on this as im a long haul flight attendant and my Dr feels this is the best treatment option for. I have been on meds for 5 months and I Have an undectable viral load and my cd4 is 500. When placed on meds my cd4 was 300 and viral load was 9000. Do you have any recomendations for once a day treatment, and that does not involve storing medication in the fridge? many thanks. Jamie

Response from Dr. McGowan

I am glad you are doing well with your medications. Twice a day medications can be tough, especially when your schedule is erractic.

There is a study being conducted to see if Raltegravir is safe and effective to use once a day...If you are able to stick it out till the results of that study are available that might be best since we know that combo is working.

Other once a day combinations may be possible, but may not be right for you for one or more reasons..the most imortant would be the presence of any drug resistance that may have been transmitted with your virus, you should go over that with your doctor/health care provider. If there is no resistance, then Atripla is a once a day combo. However, the medication can cause sleep disturance and nervous system side effects that could make it difficult for a person in your line of work (which is the reason your doctor did not recommend it, I'm sure). Another possibilty would be truvada with once a day Kaletra, a boosted PI. The issues are: it is 4 tablets of Kaletra daily, and diarrhea is not an uncommon side effect. Those are really the only options for someone with your CD4 count and need to avoid refrigeration.

One good thing also that may help is that a Norvir tablet that does not require refrigeration is expected to be available shortly, that could open up options for you, again if you can stick it out a bit longer.

Best of luck, Joe



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