Starting the treatment
May 11, 2012
Let me first thank you all for the wonderful help you have been giving to all of us. I already asked one question and was wondering if I could ask again.
I was infected sometime in Q2-Q3 2011, diagnosed in January 2012, first lab results came in February VL 147,000 CD 472. The next test from the end of April was slightly better but not much: VL 115,000 CD 486. All remaining tests were OK as well as liver and kidney function. An untreated HAV infection antibodies were found but thats all, no STDs.
My doctor believes I might be on of the few who remain with high VL regardless the time and so I should start the treatment ASAP. Would you agree?
My first question: they found resistance to NFV, fAPV IVD, SQv and ATV. My doctor said this is a rare combination of resistances. What does that mean to me? How much are my treatment options limited now?
Secondly my doctor wants to put me on Emtriva + Viread 1 tablet daily in the morning and 1 tablet of Strocin before bedtime. Is this a good first line option? What should I look out for?
Thank you all again
Response from Dr. Young
Hello M and thanks for posting.
You do have a somewhat unusual resistant virus- with pretty significant protease inhibitor resistance, but no other detected resistance. This minimally means that your future PI choices are restricted. In this circumstance (transmitted PI resistance, I'm also somewhat concerned about the rare, but possible situation of transmitted integrase inhibitor resistance- but that would depend on what country you live in and what the availability of Isentress has been. Here in the US, there have been several reports of transmitted multi-drug resistance with Isentress, but typically in patients who also had transmitted PI resistance.
As for when to start medications, in your situation, I'd agree that despite becoming infected relatively recently, your HIV viral load is high and your CD4 counts are reproducibly below 500. That would meet my criteria for considering ART-- as was the recommendation of your doctors.
The regimen that you've started (tenofovir/Viread, FTC/Emtriva and efavirenz/Stocrin) is very highly recommended and usually very well tolerated. Here in the US, this combination is often sold as the single tablet regimen, Atripla. One should be mindful of the possible side effects of the medications, typically related to the efavirenz component-- psychological or sleep symptoms- symptoms that usually improve in a few days or weeks of starting. The tenofovir component is associated infrequently, but characteristically with kidney and bone toxicity, so we're mindful of monitoring for these issues in patients receiving this medication.
I hope that's helpful. Write back anytime. BY
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