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Replace Reyataz and Essentress with Prezista?
Jul 29, 2012

Because my viral loads have been consistently near 200 (my CD4 counts always high, above 1000) and I report missing a second daily dose of Essentress from time to time and he cannot order resistance tests (viral loads have to be above 500 for that?) he wants to simplify my regime replacing Reyataz and Essentress with Prezista.

ie from Norvir 100 once Reyataz 300 once Truvada 200 once Didanosin 250 once Essentress (twice a day) 400

to"

Norvir 100 once Prezista 2*400mg once per day Truvada 200 once Didanosin 250 once

I do not feel that Prezista in any way substitutes for Essentress and would appreciate your expert advice on my situation and suggest a change appropriate to reduce viral loads.

I remember that the addition of Essentress was critical to my becoming undetectable (at 50) under prior testing standards. I have had no "side effects" and maybe 'regressed' a bit about 6 months ago but that is long over and feel in very good health now.

Response from Dr. McGowan

It would not be possible to say whether or not the switch would help without knowing the prior resistance that your virus has developed over the years. Since you are on a complex comination of old and new meds there must have been significant concern about drug resistance. The inclusion of didanosine is unusual and you should ask your doctor why he wants to retain it. If both Reyataz and Prezista are fully active (no resistance), the change would be to improve adherence. If there is some partial Reyataz resistance then Prezista may help alot. and the Isentress can be saved for later, or until a once daily Integrase Inhibitor is avaialable (maybe in the next year). If you can improve adherence and give that a shot, then a change may be less important.

Best, Joe



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