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Does reyataz isentress truvada first line therapy indicate pre-existing resistance?
Mar 11, 2012

Hi Dr. Young, I am undetectable on Atripla. My virus has no known resistance as confirmed before starting treatment. I recently had unprotected sex with another hiv positive gay man who is also undetectable on Reyataz/Isentress/Truvada as his first line therapy. Unfortunately he doesn't know if his virus had resistance, but the fact that he is on treatment with 4 molecules is alarming for me. Reyataz/Isentress/Truvada is a rather unusual combo as a first line therapy, isn't it? I know that what I did was very stupid. My question is that what are the chances that I may be exposed to a drug resistant virus? Assuming that his virus had initial resistance to efavirenz, would I be at risk for failing my treatment (Atripla)? I am quite concerned about the possible bad consequences of my irresponsible behavior. Thank you for your help.

Response from Dr. Young

Hello and thanks for posting.

I'm not one to judge irresponsibility; frankly positives have sex with positives all the time. Superinfection with drug resistance is surprisingly infrequent.

It's pretty difficult to try to read a treatment history into a treatment regimen. Your partner's drug regimen is a bit odd, but I've seen a lot of odd treatments in my day- they don't necessarily mean that there's drug resistance- though they can.

The questions about exposure to a different virus should start first with whether your partner had a detectable HIV viral load, not with the treatment regimen. If he had detectable virus, then there's a possibility of exposure. Of note, both of you are taking regimens that contain tenofovir and FTC (parts of Atripla and the ingredients of Truvada). One might actually assume that both viruses are sensitive to these medications, and therefore, you're already pre-treated against your partner's virus.

Hope that helps. BY

viral load is not yet undetectable
Sex after PEP

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