Dear Dr. Young and Dr McGowan My doctor wants to switch me to Celzentry and Isentress and Truvada. I would prefer celzentry or isentress, plus truvada. I was surprised when he told me he wanted to put me on both, plus truvada. He feels I need "more powerful" then just one or the other. My tcells have been around 150 for 2+ years now, even though 2+ years ago I started Kaletra and Truvada. Viral load undetectable. I have been HIV+ since 1986 and am a 49 year old woman with Hep C (stage 2 result from biopsy. I hope to get into a new (non interferon based) Hep C/HIV study in November, or when they become available. I had a severe reaction to reyataz, dapsone etc. Can you advise? I would prefer to try to convince him to do one vs the other, especially since I will be on more (experimental) drugs when I enroll in the Hep C study. Thank you. Felicia

Dear Felicia,

The need for an additional medicine may be related to any past drug resistance that may have developed in your virus over time. Since you have been infected since 1986 (and by the way...Congratulations on doing so well!!) it is possible that previous treatment may have selected some drug resistance in your virus.

We always need to have a total of at least 3 ACTIVE medicines when on treatment. There was a study switching from a "boosted PI" such as Kaletra to Isentress along with truvada in which many patients who had long history of HIV did not do well, probably related to past unrecognized treatment failure. So, your doctor may be trying to be sure that the wall against HIV is high enough to stop the virus from breaking through. If past resistance is not an issue, than either 3 drug combo might be fine. (For Selzentry you have to be sure that a "tropism" test shows that the virus is susceptible). Joe

Joe