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TREATMENT REGIMENS

Nov 20, 2013

I have been on Reyataz Norvir and Truvada since 2006 and have attained good results. I am however, concerned about osteo, kidney and lipid issues. I am 58 years old. Some folks have switched to Isentress/Truvada (is this a once a day regimen or twice), Prezista I was told could be switched for Reyataz, and now the new drug Tivicay (doultegravir) I think gets paired with Epzicom.

Could you tell me what some of my treatment options are? Is there a table that shows treatment options with side effects?

Greateful.

Response from Dr. Young

Hello and thanks for posting.

Seems like you've been doing well on a DHHS-recommended first-line regimen. At age 58, it's entirely appropriate (as it would be if you were younger too) to monitor for any risks or complications of your treatments.

Indeed, providers are becoming increasingly aware of the issues of non-communicable, non-AIDS-related complications, such as bone , kidney or cholesterol issues.

If you don't currently have evidence of risks or problems related to these (and other) complications, there might not be reason to change your otherwise very successful treatment.

That said, it's always reasonable to look at newer science and treatment options. As you've pointed out, darunavir (Prezista) is an alternate PI option that also is recommended in current guidelines. It has the main difference of having fewer drug interactions and less risk of appearance-related side effects. A different approach would be use an integrase inhibitor, such as dolutegravir (Tivicay) to replace the Norvir and Reyataz- this has been shown to be better tolerated than darunavir in a head-to-head large study and eliminates the need for the Norvir boosting.

With regard to Truvada vs Epzicom, the former appears to be working well for you- but with regard to your question, it's reasonable to know if you have risks for any of the characteristic side effects of the tenofovir part of Truvada. It's recommended that your kidney function (by testing both blood and urine) and bone density be evaluated. Many providers are unaware of the recommendations to test all positive men over the age of 50 for risks of osteoporosis. If this hasn't been done, I'd suggest speaking to your provider. If you don't have such risks, there might not be any reason to switch (although a single pill combo with Epzicom and Tivicay is in the works).

On the other hand, there's evidence that Epzicom is not associated with significant kidney or bone risks; it's also very potent when combined with Tivicay (and this treatment is among the most recent additions to the DHHS Panel's recommended regimens. If your genetic testing (called HLA B5701) is negative, Epzicom might be an option for you.

The US Department of Health and Human Services (DHHS) Guidelines has an excellent, comprehensive set of tables that characterize the various medications and their attributes.

Hope that helps, BY



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