Jul 28, 2011
I would appreciate a "second opinion". I have been on meds a long time: years of sequential monotherapy followed by Combivir+Crixivan in the late 1990's. I experienced drug failure in 2001. After a resistance test, my I.D. doc put me on Kaletra, nevirapine, tenofovir, and abacavir+lamivudine. That's a lot of drugs but my viral load has been undetectable without a blip since that time (and where I live, that means below 40 (forty) copies). My new I.D. doc thinks I may be "overtreated" and is suggesting a switch to Truvada + Isentress + (either Kaletra or boosted darunavir). I'm tending toward the combo with Kaletra because I have lots of experience with it an no side-effects. However, my philosophy has always been: "if it's not broken, don't fix it". I'm a bit nervous having gone through drug failure once before but the idea of less pills (assuming they will be just as effective) is very appealing. What do you think? Thanks for your help.
Response from Dr. McGowan
Thanks for your question.
THere are many patients in your situation. Your virus had a chance to develop some level of resistance against the older meds...and then you got what we called a "mega-HAART" regimen to suppress everything. It works but there may be opportunities for simplification.
The key is to be sure that there are at least 3 (or the equivalent of 3) fully active meds in the combination. This may consist of 3 meds, each with full activity or a combination of multiple drugs some of which are partly active and some fully active.
I cannot tell you if the suugested regimen will work for you or not without knowing all of the past drug resistance test results and the responses to each of your past treatments. The key is for your doc to review them and see whether or not Truvada/Kaletra/Isentress would add up to 3 fully active drugs. Essentially you would be dropping abacavir and nevirapine and picking up Isentress. Isentress can count as a fully active drug, but is it replacing 2 active drugs??? This is what you need to review with your doctor, also ask if they feel, based on the past treatments, that your virus may have less resistance against darunavir than Kaletra, that may add at least some partial activity. Since it is a matter of simplificatio and not a change based on toxicity you have time to flesh it out. Also, if you change, be sure to have close follow-up to confirm that the viral load stays less than 40, not just the routine 3-4 month testing.
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