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need help..confussion abt medication....
Jan 30, 2011

Dear Dr Benjamin Young, this is my 2nd question in forum as did not get reply for 1st one...hope to get this time....I am female 32, HIV positive since 8 years...My recent last month reports are CD4 72 Cell / mm3 & 6.93 %, CD3 937 Cell / mm3 & 89.72 % HIV 1 viral load 483,000 copies / ml plasma Log Equivalent 5.68. This was in last week of December 2010. I saw doctor and he asked me to start Bectrium which I did immediately. After 10 days he suggested me for HIV medication combo of Truvada + stocrin AND Truvada + Isentress. Understanding the less side effects of later combo I decided to go with it. Now I m taking 1 Bectrium + 1 isentress 200 in mog 9 AM & 1 truvada + 1 Isentress 200 mg in evening 9 PM. For first few days I had chest pain, headache, some rashes on body, vomit etc, now it looks good except the leg pains. I did my kidney, liver, CBC, chest x-ray and eye x-ray test. All seems ok except little anemia. Now I am going to do again kidney test and hepatitis b & c test this week.

I want to know If the medication I am taking is correct and enough. Dosage of Isentress is enough or it should be 400 mg. My doctor has told be that this combo is for 2 months only as isentress is very expensive drug. Later we will switch to other combo. Can you please suggest if it is ok to do and if yes what would be the perfect combo? Are there any other tests I should do?

Desperately await your answer.

Response from Dr. Young

Hello and thank you for your post.

First, both regimens that your doctor proposed are fine- tenofovir/FTC (Truavda) is widely regarded as a component of first-line HIV treatments and is generally well tolerated. We will try to avoid it principally in persons with kidney or bone disease (but it does not appear that you have either).

As for the efavirenz (Stocrin, Sustiva) and raltegravir (Isentress), both are part of preferred first-line regimens in the US (I'm not sure what country you live in), but you're correct that the later is dosed twice daily and is more expensive in many countries. The standard dose of Isentress is 400 mg, twice daily, so I'm concerned that I may misunderstand how the medicine is labeled in your country (it's only available as a 400 mg tablet).

Here in our the US, we'd generally keep the patient on their first-line regimen, but provided that your viral load is undetectable and that there was no evidence of baseline drug resistance (particularly to efavirenz), then switching to efavirenz later would be safe to do.

I hope that helps. Stay in touch and be well, BY

Switching from Atripla to Truvada/Isentress

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