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Switch to dual therapy?
May 23, 2012

I've been positive for 30+ years. Current successful regimen for 11 years is Kaletra, Rescriptor and Truvada. Only resistance is to the NRTI class from much prior therapy. My doc does not have a ton of HIV experience, but she and I want to simplify my therapy. Can I drop the Truvada (probably not working anyway) and the Rescriptor (not very potent) and add an integrase inhibitor? That would be powerful but very simple. Any thoughts? It seems that I will have to be making my treatment decisions. Thanks, as always, for your work.

Scott

Response from Dr. Young

Hello Scott and thanks for posting.

Sounds like you're on a somewhat dated regimen, so I'd agree with your doctor that it's a reasonable time to consider your options.

First, we usually recommend using three active components and unless there is a really compelling reason, avoid using two drug therapy. The possible exception to this rule is when one of the medications is a ritonavir-boosted protease inhibitor. The boosted PI darunavir (Prezista) or atazanavir (Reyataz) might offer better tolerated, lower pill count simplification from your Kaletra.

With regards to your regimen choices, much depends on the precise details of your NRTI resistance. I use the Stanford HIV Drug Resistance website as a free resource to see if your old HIV resistance pattern holds any sensitivity to contemporary NRTIs, like tenofovir. If so, then continuing Truvada might be reasonable.

I'd also recommend that your doctor have a chat with a HIV expert (she'd be welcome to contact me, if it helps) to discuss the pros and cons of the various strategies.

Be well, BY

Integrase inhibitor raltegravir is very potent, but somewhat vulnerable to less than fully potent regimens (ie., 2 drug regimens), so I wouldn't recommend this unless partnered with a fully potent background regimen (or, perhaps a boosted PI).



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