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Switching to Complera
Nov 27, 2012

Hello

I started treatment Prezista + Norvir + Truvada (1 take / day) 18 months ago and I have had VL < 20 for 15 months; i have 0 side effects, blood tests are all good.

The Doctor wants to switch because thinks current regimen is very strong and after this initial period, wants to switch to treatment with fewer long term side effects.

He suggests: - switch to viramune (very good long term results and good on reservoirs) - switch to complera

He refuses Atripla as he really does not like the side effects on the brain.

Regarding Viramune, i already discussed it here and was told it should be avoided because of its short term toxicity

Regarding Complera, I'd like to have clarification; when going on the medication page of this website and looking at complera articles: + in the "Basics", article from September 17, 2012 => Complera is not to be taken by people that already had other treatments + in the "News & Research", article from August 3, 2012 => Switching From Protease Inhibitor to Complera Maintains Viral Suppression

Which one is to be considered right?

Could you give me your overall opinion about the situation and the options the doctor gives?

Thanks

Response from Dr. Young

Hello and thanks for posting.

I'm not sure what your doctor means when he says that your regimen is too strong- your current combo is one of just a few designated "preferred" first-line regimens in current US treatment guidelines.

Switching should be done to improve adherence, tolerability, side effects or toxicity; this decision should be done thoughtfully to balance the risks of new problems versus the risk of continuing on your current regimen (which appears to be working very well).

Having said that, if the goal is to switch off of the boosted PI darunavir (Prezista), then the switches discussed replace the PI with NNRTIs- either nevirapine (Viramune) or rilpivirine (Complera). Borrowing from the US DHHS Guidelines (see table 5a), you'll see that rilpivirine (Complera) is ranked higher than nevirapine- for a variety of reasons that include toxicity profile and co-formulation (fewer pills). Short term toxicity of nevirapine is mostly when the medication is started in treatment naive persons and less so in people like you.

As for Complera, the medication is formally approved for initiation of treatment and not fully evaluated by the FDA for stable switching from other regimens, though as you point out, there are studies now that support this strategy. Clinically speaking, we've switched patients from other regimens to Complera without event, so overall, if the diet and antacid restrictions of Complera are acceptable to you, this would be my preference.

Hope that helps, BY



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