|Two Drugs Only?
Jun 29, 2012
I've been on Isentress and Truvada for about three years now, and was reading on a few other forums that two drugs-only, may now be used in some patients. Have you heard of this before? Have been undetectable for over six years.
| Response from Dr. McGowan
Thanks for your question. There have been a number of "Induction and Maintenance" schemes that have been tried over the years. This is when a combination of 3 or more drugs (as what you are using..since Truvada has 2 drugs in it) is used up front to get the virus under control and then some of the meds are stopped and you "maintain" the suppression with 2 drugs. Generally these strategies have failed because the 2-drugs were not sufficient to keep all the virus in the body suppressed. This would usually be the case if 2-nucleoside reverse transcriptase inhibitors (NRTIs) were the remaining meds, such as the truvada part alone. Ons study that simplified to a boosted protease inhibitor for maintenance did better, especially if the person had viral suppression for a prolonged time before the others were stopped. Some drugs, like certain NRTIs, NNRTIs and integrase inhibitors may not work well in this type of strategy beause they have a "low genetic barrier to resistance", which means the virus only needs to pick up 1 or 2 mutations and it has become resistant. For a boosted protease inhibitor (a PI combined with ritonavir) the barrier is high...requiring the virus to develop several mutations to break through.
Hope this helps.
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