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Treatment switch part 2
Dec 29, 2012

Dear Dr.Young thank you very much for your kind reply for my last question but unfortunately I had left out some important information.Me 63y old& HIV treated since 1986....in fact my combo since 3 years was Kaletra/Isentress/Tenofovir/Prezista/Intelence taken twice a day.I asked my Doctor to receive a "lighter" treatment like Comblera plus one more med taken once a day.My Doctor prefer to leave out Intelence&Kaletra ,it will leave me with 3 meds still twice a day.Do you think it would be sufficient or would it not be preferable and also more profitable to me to insist on Comblera plus one more med once a day?I feel quite frustrated not to receive Comblera as it is seems very well considered and appreciated in most trials.I understand your difficulties in replying back to me on this as you do not have seen my bloodworks& resistance test but I would very much appreciate your input/ feeling about such a switch. I thank you deeply in beforehand and wish you a great end-of-year celebration with all my thanks for what you have one for us dying this year.

Response from Dr. Young

Hi again and thanks for posting.

I'm not sure about the basis of your frustration, other than it's understandable that you'd like to have a more simple regimen to take.

I'm afraid that it's probably unlikely that you'll be able to use the Complera + 1 additional strategy- though it'd be good to ask your doctor about the suitability of this based on your previous drug resistance tests.

The rilpivirine NNRTI part of Complera doesn't have activity in viruses that have previous resistance to other NNRTIs (like efavirenz or nevirapine), whereas etravirine (Intelence) may. Complera might be well tolerated, but if there isn't sufficient activity of the regimen, it's use won't be helpful if you risk treatment failure and additional drug resistance.

It might be possible to use the new once-daily integrase inhibitor combo elvitegravir/cobicistat (found in combo with tenofovir/FTC in Stribild), as a Complera substitute. This would then provide a replacement for your current tenofovir and Isentress.

The fact that you're taking a dual boosted protease inhibitor regimen of Kaletra + Prezista suggests to me that you've got pretty highly resistant HIV. Since earlier studies haven't shown much benefit of using two PIs, is conceivable to me that you might be able to simply this to only one of the two (though if you use Prezista, you'd need to add a boosting dose of Norvir).

It is worth spending time working with your doctor to compile your previous treatment (and treatment failure) history and your HIV drug resistance tests. Using these data, fill out the Stanford University HIV Resistance Database to estimate which drugs your virus is resistant to and which drugs may retain activity. If then you can identify those important three active (and hopefully coformulated and once-daily) medications, you'll be able to make an informed decision about your options.

I hope that helps and wish you a healthy new year. BY



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