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follow-up question (Running out of medication options)
Jun 5, 2013

Thanks for your response. My brother discussed tiprinavir/norvir, etravirine, and raltegravir (he still refuses to take T-20). His doctor advised agianst using the above, saying that the tiprinavir/norvir lowers the blood level of etravirine significantly. Do you think tipranavir/norvir+rilpivirine+isentress (or the new integrae inhibitor) would work? Thanks again

Running out of medication options May 14, 2013

my brother has been HIV infected for 25 yrs. His virus is resistant to all drugs except the new etravirine, rilpivirine (and never took integrase inhibitors). other tests are predicted resistant based on testing, except possible partial resistance to tipranavir. He does not want to take T-20. his doctors is not coming up with a new drug recommendations. he has been on Prezista, norvir, truvada for more 5 yrs and his viral load is stable ~4000-8000, &CD4 ~300. His doctor is telling him to stay on same drugs he calls it partially suppressive drugs while waiting on hopefully new drugs to combine with the ones his drug is sensitive to. Please advise. what should he do, just wait on same drugs as long as CD4 viral load are relatively stable?? any trial you would recommend. he is in Texas. Thank you in advance

Response from Dr. Young

Hello and thanks for posting from Texas.

Sorry to learn about your brother's difficult treatment situation. I agree with his doctor that it's good to hold out to treat him with a fully potent next regimen- one with at least 2 and preferably 3 active medications. With a stable viral load and non-critical CD4 count it's reasonable to be patient to find a good regimen.

However, it would appear that he could have such a regimen with retained sensitivity to tipranavir (only partial), 2 different NNRTIs (riplivirine and etravirine; only 1 would be used) and most likely to the integrase inhibitors and T-20.

A salvage regimen of boosted tipranavir, etravirine and an integrase inhibitor (raltegravir, or perhaps even better would be the soon-to-be approved dolutegravir) would likely be an effective one to suppress your brother's virus. (Dolutegravir is available for compassionate use prior to FDA approval).

Response from Dr. Young

Hello,

You're right. There is a significant drug-drug interaction between etravirine and tipranavir and the two should not be taken together.

Rilpivine might be an option, depending on your brother's drug resistance mutation profile. I use the Stanford Univ HIV Database to get a high quality and free assessment of possible treatment options.

Hope that helps and wish you both good health, BY



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