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Cocktail Choice

Oct 12, 2012

Hi Drs. Young/Mc Gowan. My current cocktail consists of Viracept, Viread and Isentress. VL is undetectable and CD4's are @ 580. I would like to take advantage of the newer cocktails available, namely Complera and Stribilid. Only problem is...I am resistant to the Emtriva and Sustiva. Is there any way to formulate a cocktail using the "newer" drug combos considering my resistance to Emtriva and Efavirenz? I would really love to get away from a PI based regime. Thank you .

Response from Dr. Young

Hi and thanks for posting.

Yours is a very good question, that harkens both to the time when many people experienced treatment failure and also to the good news of newer, better tolerated and easier to take medications.

First, if you have the drug resistance mutations handy, you can input them into the Stanford University HIVdb database, just to make sure that any planned treatment is going to have at least 2 and preferably 3 active medications.

With your stated resistance pattern, and knowing that you're currently suppressed on a early PI, tenofovir and an integrase inhhibitor, it's not a very far reach to suspect that you'd have good activity with the Stribild combination (that uses tenofovir, FTC and the new integrase inhibitor, elvitegravir). This later regimen has 2 active agents and while we sleep better with three active agents, a switch while undetectable probably doesn't have the same set of requirements as if we were starting from scratch (and with a detectable viral load).

I'd talk to your care provider, for his or her thoughts.

Be well, BY

Resistance and what next
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