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Is this medication regimen correct?
Jan 30, 2010

I am a 55 y/o female and have been hiv+ since 1992. To make a long story shorter, I was on Truvada/Viramune for a long time but then my kidneys started to fail. Yesterday I found out that my tcells are a little over 300 and vl 4K. The doctor has prescribed Isentress/Reyataz/Norvir. Isn't this only a 2 drug regimen, with the Norvir just a booster? I called the doctor's office and was only able to talk to the nurse, and she confirmed that yes, this was the correct regimen. I am so confused and don't know what to do.

Response from Dr. McGowan

Thanks for your question.

Yes it is a 2 drug combo, but there are some strengths to it. The "boosting" effect of the norvir makes the Reyataz a powerful drug and the Isentress is also new and very potent. Many people have great success with boosted PIs alone (although this is not recommended due to a higher overall failure rate). Combinations of "boosted" protease inhibitors, like reyataz + NNRTIs (like efavirenz) also did well in many people (again only 2 drugs, but very strong ones). Efavirenz would not be an option for you because your virus is likely resistant since this drug is closely related to viramune. Your doc is trying to avoid Truvada because of your kidney problems. You should ask if Epzicom (another combo in that class) is an option for you. The most important issue for your decision would be what you had taken in the past. If your virus already has some level of resistance to protease inhibitors, then this combo might be very compromised and would not be recommended. You would then have to rebuild the combo with 3 active drugs, perhaps with maraviroc (also a "new" drug option if your virus tests "susceptible" on a tropism blood test)

Best, Joe

efavirenz resistance
Why would my doctor prescribe Isentress once a day?

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