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Dec 19, 2011

When will you start to use an entry inhibitor and can it be combined with EFV, 3TC and TDF?Patient is stable on EFV,3TC and TDF the CD4 count remains at 470- 475 with undetectable Viral Load rest of blood results normal.Do I need to change the regime.I am interested 6to know when do one use entrance inhibitors.I have asked experts on HIV and cannot get a clear answer.Regards Dr.F.Booyens South Africa

Response from Dr. Young

Hello Dr. Booyens and thanks for your post from South Africa.

Entry inhibitors (maraviroc, MVC) have been added to the US list of alternative first-line agents. While most of the literature on MVC is derived from the treatment-experienced clinical trials, there are also data for first line use from the Merit clinical study.

There's no data that I'm aware of adding MVC combination with TDF/3TC and EFV- nor would I expect significant additional benefit in a patient already experiencing viral suppression on the regimen.

Here in the US, we use MVC in patients with CCR5-tropic virus, either to construct a potent regimen in drug-resistant patients, or for select first-line patients who have relative contraindications for the use of more orthodox 3rd agents (NNRTIs, PIs). Our experience has been positive, with excellent tolerability to date.

I hope that helps. Please feel free to write me back with any follow up questions. BY

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