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Is it worth the risk?

May 14, 2012

Hello, I've had HIV since age 16, AIDS diagnosis at age 17 and just I just turned 38. Had my share of ups and downs and very close calls but for the last 4 years I have been undetectable with a CD4 near or over 400? Its been wonderful, and a first! That said I've had an extensive history with almost every medication and combination. My main concern is that I have a family history of heart disease and I am about the age it strikes. Recently requested some heart tests due to high triglycerides which usually range from 500 to 1000. Results were calcium score in LAD around 300 but the rest of the heart pretty minimal. Stress test was fine. I've completely changed to a plant based diet. The result from this change will take a few months but my doctor has suggested a couple of times that there may be a new option which I suspect is the QUAD. Presently, I am on Isentress, Prezista, Selzentry and Norvir. It seems like the PI's are the main reason I have such problems with triglycerides. Is there any evidence that the new QUAD formulation is better i.e. not as harsh on lipid levels? I worry most about switching and developing resistance and returning to the old days of constant anxiety. Is there any literature on lipid levels with this new combination? On the plus side the new combo would save me lots in co-pays and simplify the number of pills I take. Thank you for your time and all that you do!

Response from Dr. Young

Hi and thanks for posting.

Seems like you have a quite extensive treatment (and possibly, therefore, HIV drug resistance) history. As such, I wouldn't be leaping to switching you to the Quad unless there wasn't any history of NRTI resistance. Notably, you're not taking any NRTIs which leads me to have concern about resistance to this class and therefore possibly impaired potency of the Quad's tenofovir and FTC.

I agree that you've got reason to be concerned about cardiovascular disease, with your strong family history. In putting all this in context, it's important to know that controlling HIV's viral load is probably the single most important thing one can do to decrease the risk of HIV or HIV meds in heart disease- I wouldn't want to jeopardize this control at the sake of the admittedly attractive pill count and tolerability of Quad.

So for now, I'd definitely work on all of the other modifiable cardiovascular risks as you have with your diet- but don't forget exercise, blood pressure and diabetes control and oh, yes, don't smoke.

I hope that's helpful, BY

Medication combination advice needed
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