Decision to Swith Treatment?
Aug 28, 2013
I was diagnosed via NAT test (antibody was neg) with VL >13 million. Placed on Truvada + boosted darunavir until resistance testing was done. Resistant to EFV, decided to try Complera with VL ~ 1300. After 20 weeks, VL is 290. Is this considered reasonable? Or should I consider another line of therapy (e.g. integrase inhibitors)? Thank you in advance.
Response from Dr. Young
Hello and thanks for posting.
Let me get this straight, your baseline drug resistance test showed resistance to efavirenz, and your doctor switched you from a fully potent boosted protease inhibitor (darunavir) to rilpivirine. The first question is why switch? If you were tolerating the medications and pill burden, the first regimen is among those rated as preferred by current US treatment guidelines. I would have been tempted to wait until your viral load reached undetectable levels, especially since you started with such a high VL. Complera is typically recommended for people starting treatment with VL's less than 100,000 copies, but recent data suggests that this restriction isn't as significant among people who's viral load is suppressed.
Having said that, provided that your resistance test showed only the K103N efavirenz resistance mutation, the switch to Complera (and rilpivirne replacement of darunavir) should be acceptable. Either way, work to stay as adherent to the Complera regimen, including taking your pill with meals.
I hope that's helpful, BY
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