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First line therapy....... please help
Apr 26, 2012

I am a domestic abuse survivor and I was raped repeatidly and my abuser infected me with Hiv. I have never been a drug user or had multiple partners so I am healthy other than the hiv. I am about to start treatment and my doctor has prescribed truvada and isentress as my first line regimen but I also went to see another dr. that was concerned about that combo for first line of defense . She said that it might be better to use that later down the road so she suggested intelece and truvada combo. I am so confused now so could you tell me what you think would be the best choice. Thank you so much for your time.

Response from Dr. Young

Hi and thanks for posting.

There is no single best regimen as a number of viral, medical and lifestyle factors play important roles. Since both doctors recommended Truvada, I'll assume that you don't have underlying kidney or bone issues.

Then the differences in opinion stem from the choice of the so-called third medication. I'd ask you why your doctors recommended twice-daily versus once-daily options. Having said that, raltegravir (Isentress) is one of the US treatment guideline "preferred" options, whereas etravirine (Intelence) is not cited as either a "preferred" or "alternate". Based on this simple deferential statement, I'm confused as to why the second doctor recommended this 3rd drug in lieu of the many others (including Isentress).

We have had very good success with the Truvada (or it's alternate, Epzicom) with Isentress for many patients. The regimen is very well tolerated, and save for the twice-daily dosing of Isentress, has been very convenient to take, with no restrictions on food or time of dose. Yes, it's reasonable to have some appreciation for the downstream treatment options as alluded to by your first doctor, and indeed, failure of any treatment regimen can pose risks of drug resistance. For this reason, my first response is to work diligently to support and reinforce adherence to the treatment and to monitor side effects and lab responses very closely. With today's options, a well-adhered regimen only very rarely fails with drug resistance.

I hope that's helpful, BY



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