Dec 5, 2012
My doctor recommends that I now consider switching to a new cocktail combination after three lab tests show inrease in viral load from 50 70 220. Was on Trizivir for at least eight years of being undetectable. T-cells average 740 but latest CD4 is 659. He rather have me switch then do a genotype in order not to develop further resistance. In 2010, I tried Isentress and Epzicom for three months to avoid possible side effects of AZT and was undetectable for the first month. It was stopped because tinnitus resurfaced. I went back to Trizivir till now. What are my new options now ? He said the my virus is wimpy since I had Trizivir for that long. Viramune and Epzicom I had already tried but had liver issues. I had tried Viread with Combivir and GI problems so that it seems Trizivir is very tolerable for me. I did took Veracept and Combivir for three years before but had stomach pain that brought me to the emergency but nothing conclusive to its cause. Again Trizivir was my lifeline. I know there about seventeen drugs to choose from. Can eI take just two drugs for now like Issentress and Ziagen but my doctor wanted to add Edurant. What do you think?
Response from Dr. Young
Hello and thanks for posting.
If I understand your post, your viral load went from undetectable to 220? Long before I'd consider switching a long-time successful regimen, I'd be inclined to repeat the viral load test.
Many insignificant things can cause low level detectable VLs- even something as benign as a cold sore or sinus infection can do this. So before switching, this would be my first action.
Indeed, if your viral load is only ~200, a resistance test would not be able to be done, since you typically require a viral load of 500 or greater to get a result.
If a repeat test confirms the viral load increase (and there's no other clinical or adherence reason for this), then switching makes sense. A two drug regimen is definitely *not* recommended, since two drug regimens are more likely to fail (with additional drug resistance) than three or four drug regimens. Absent a resistance test, we'd have to assume a higher degree of resistance at this hypothetical point.
Second-line regimens after failure of Trizivir (or Epzicom) would usually include tenofovir/FTC (Truvada) with a third agent. Since you've likely developed resistance to any of these third drugs, you can largely pick among the many- including the DHHS preferred agents, efavirenz (Sustiva or Atripla), rilpivirine (Complera), darunavir (Prezista)/ritonavir, atazanavir (Reyataz)/ritonavir or perhaps, raltegravir (Isentress).
Know that among all of the approved and well-studied options, that there certainly a well tolerated option for you.
I hope that is helpful, BY
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