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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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