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Treatment selection...tough time

May 24, 2012

Hello I got infected in january 2010, had viral level gradually increasing from 30k to 400k from july 2010 until may 2011 where i started Prezista + Norvir + Truvada. I got undetectable after 2 months and undetectable since then (all blood results are good, cd4 stable at 32% (650)), the only "abnormal" number being CD8 (stable at 52% / 1000))

Specialist don't want to keep me under current regimen as he thinks this is very heavy treatment and that we should switch to lighter one now that i have been undetectable for a year. He proposes as 1take/day treatments: Atripla or Viramune coupled with other pill or quads (he can include me in a trial for quads) He says there is no one better than another one, nevertheless, what i understand: - he thinks viramune is a good alternative, that we should monitor closely for the first 3 month because it can cause some very bad reaction (rash and / or liver problem), but that this is a great long term treatment that can also facilitate decrease CD8 although he says there is no clear study on this) - he thinks atripla can have bad side effects (although it is very popular in the US) - he thinks Quads could be a great deal for me but on this one, i am not keen to switch for this because it would mean doctor change (i would go to study team instead)

What is your opinion? what do you think of all this? Thanks a lot for your view

Response from Dr. Young

Hello and thanks for posting.

Sounds like you're doing very well on your current regimen. Before speaking to switching treatment, I should say that your current regimen is among only 5 "Preferred" initial regimens in the current US treatment guidelines. As such, I'd be hard pressed to say that your treatment needs to be changed. I also recognize that you don't live in the US, so be mindful that different countries view these recommendations with different strengths.

Using the US treatment guidelines as an outline, switches in regimen could be considered to improve adherence, decrease pill number or dosing frequency or to avoid toxicity or side effects. Atripla is one of the other 5 "preferred" regimens, and has the advantage of one pill, once-daily dosing, but adds the potential of efavirenz-related side effects.

The guidelines have demoted nevirapine regimens to the 3rd tier, "Acceptable" category, so I'd be hard pressed to suggest that this would be a best-choice option (given all of the other "preferred" and "alternate" regimens out there.

As for the still experimental Quad (tenofovir/FTC/cobicistat/elvitegravir), a clinical trial offers some potential advantages (increased safety monitoring, no-cost medications) but one should carefully weigh the potential benefits against the potential risks. Quad has recently been recommended for full FDA approval, so the relative uncertainties of this medication (compared to other studies) is low. Quad also offers one pill, once-daily dosing with an excellent side effect profile. Lastly, if you're in a study, this doesn't necessarily mean that you have to give up your doctor, rather, you'd be seeing the study team for study related activities, but would likely still be able to see your current doctor too.

I hope that's helpful, BY

Starting Meds for the first time

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