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Switching from Epzicom/Isentress to Complera
Apr 1, 2012

Hi, I started first treatment 3yrs ago with Epzicom and Isentress with a VL @ 100,000 and CD4 at 550. After 6wks my VL was undetectable and CD$ 650. This regimen includes taking Isentress twice a day. I have continued to do well except some weight gain and a couple of bouts of shingles when I first started and have remained undetectable. I would like to switch to the once a day Complera for convenience mainly. I have relocated and have seen a new physician once. I would like to discuss the switch with him on my next visit. My questions: Is Complera only for those who are new starting meds and if not, how do I make the switch? Do I have to stop current regimen for a time period before starting Complera or can I just start taking Complera the next day? I understand the importance of taking it with the meal and eliminating the PPIs. Thank You.

Response from Dr. Young

Hello and thanks for posting.

Simply said, you could switch directly from your current regimen to Complera without need to interrupt treatment. You've stated correctly the dietary requirements of the new medications.

Now, that said, since you're entertaining a switch of your nukes from Epzicom to tenofovir/FTC, be sure that you and your doctor have assessed your kidney health (and if you were in our clinic, bone/osteoporosis health), as tenofovir is associated with some risk of injury to these organ systems).

I'm a conservative treatment switcher; so that if the goal of switching is to get to a once-daily regimen with Complera, a less dramatic switch would be to continue Epzicom (at least for now), and change out the Isentress for rilpivirine (Edurant, the NNRTI part of Complera). This would allow monitoring for the tolerability of one drug switch at a time. If after a month or so, symptoms are good, then one could consider the switch of the additional components, if desired.

Many in our hood are also anticipating this summer's FDA approval of the Quad single tablet regimen that uses tenofovir/FTC with Gilead's new integrase inhibitor, elvitegravir. One might ask if this switch is also something to consider, since you'd be keeping the integrase class of medication and avoiding the potentially nuisance issue of the fat-containing dietary restriction of Complera. Food (pun intended) for thought.

I hope that's helpful. BY



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