Ziagen plus Atripla?
May 3, 2009
Dx'd HIV+ 3/07, put on Ziagen and Atripla. My new internist says this is wrong because she says I'll be likely to develop a resistence to all PI's. My HIV dr., a professor of infectious desease at the U. of Chicago, when I told what the internist said (he was on my neck for the last year to get a "family Dr." in the first place), he said have the internist treat me from now on. The internist is Infect. Desease Bd. Cert. and sees AIDs patients all the time. I like my original doctor, but why won't he explain to me why he put me on Ziagen with Atripla ... or even give me his opinion now? I feel like I should now get a third opinion. I've been undetectable from the start of taking the drugs. I'm hardly a patient pest... I only saw my HIV dr. once in 2008, and 2 wks ago ...and I never call him about anything. I'm 1000% adherent and NEVER missed a single dose. So what's the big deal ... I thought it was always OK to get another med. opinion. Now I'm afraid of my own shadow and don't know what to do. Thank you!!!!
Response from Dr. McGowan
Sometimes the combinations that are chosen have to be highly individualized, which means that one size does not fit all.
First of all. For most people starting out on treatment, atripla alone (which contains 3 drugs) would be adequate. The decision to add a 4th drug might be made if there was some drug resistance present in your virus when you became infected. That might require the addition of another medicine to ensure that at least 3 were fully active. Also, in people with high viral loads (over 100,000) it may be harder to suppess the virus and some providers like to add additional drugs to be more sure that the levels will come down to undetectable. This approach has not been validated by studies, but it may be a rationale for the extra med.
There would be no risk of developing PI resitance from your combination since it does not include a PI. Resistance is generated by incomplete suppression of the virus. The virus mutates to find an escape that lets it grow in the presence of the medication. The virus can only respond to what it is exposed to, so if there is no PI, it will not develop PI resistance.
Doctors are people too, if your original doctor feels insulted that you got another opinion and you do like him/her, you should explain that you are interested in being as educated as possible about your health and treatment. A doctor who is secure about his/her ability and decisional process should not be threatened by that. It is generally welcomed. If your doctor will not or cannot respond that may tell you something about their comfort with making these decisions.
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