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Unable to reach undetectable - clarification

Aug 30, 2010

Dear Dr McGowan

Thank you so much for your reply, much appreciated! You mentioned that intensifying treatment by adding a nucleoside such as truvada may help to knock down the vl to undetectable. I have just started (today) to take 3tc alongside my other meds. Am I right in thinking this is a nucleoside - would it be as effective as truvada? Regarding changing to twice daily darunavir/ritonavir, I had a drug level test done recently which showed that the levels of all my meds were well above guidelines at 24 hours. Taking this into account, would switching to twice daily be of benefit? Finally, I take one 300mg maraviroc pill once a day, I didn't realise that 150mg pills existed! I'll ask my Doc about this!

Many thanks

Your worried patient from the UK!

Response from Dr. McGowan

Thanks for the follow-up.

Blood levels are important but must be based on the individual case. If your virus has a bit of resistance to treatment, a higher than average level may be needed.

3TC (lamivudine) is a nucleoside, truvada is a combination of 2 NNRTIs (tenofovir and emtricitabine) and would be more potent. Intensifying treatment with a drug like 3TC, which only requires a single resistance mutation by the virus is not usually enough. (Note:3TC is a bit unique in this regard and we may add it on after the virus is "resistant" because the mutation that conferes 3TC resistance slows down the virus ability to grow and may help even though the main effect of the drug is not there).

Definitely look into the usual dosing for maraviroc...sometimes little changes can mean alot when the VL is so low.

Best, Joe

changing medication

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