Dec 20, 2012
I was in the Midas Study for 48 months (Ritonivir )100mg), Darunivir (800mg), and Maraviroc (150mg). My response was great (780 average CD4) and undetectable since 6 weeks into the study. My new doctor (I moved) is worried that the combination may not be durable (low Maraviroc dose). Do you see a problem? I've been on the drugs now for 2-1/2 years and great results. My new doctor wants to move me to Stribild. Do you see a problem? Should I switch. As a side note, I've been having off and on again joint pain and I think it may be the Maraviroc. Thanks!
Response from Dr. McGowan
The preliminary results from the study were presented this summer at the International AIDS Conference. The combination worked well, but there were signs that it may not be as potent as we now expect from first line treatments. This was suggested by the finding of more treatment failures (incomplete suppression of virus to undetectable...a very strict definition of treatment that we have come to expect from new treatments) among patients who started with the highest viral loads (over 100,000 copies). This is the real "stress test" for any combination. Some of the breakthroughs happened later as well...after 24-36 weeks of treatment despite strong adherence. I do not blame your doctor for suggesting a regimen that has more supporting data. That being said 2 1/2 years of success is very reassuring, and we all have patients doing very well on therapies that would not pass muster by today's high and rigorous standards. If you stay on the current combo, just maintain strict adherence and come regularly for your testing. If you virus is detectable at any measures, that could be a prompt to change early. Joint pain was a rare side effect of maraviroc (between 1 and 2 per 100 patients), so it is possible that your pain could be related to the meds. This may the the key factor if you do decide to switch.
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