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Stribild, Triumeq, or something else?

Oct 28, 2015

Hello, I have been HIV+ for 14 years and I have never been on medication, recently my t-cell count fell to 400 in August, and back to 475 just last week. Those were the lowest numbers I've ever had since being diagnosed. I am a recovering crystal meth addict, social drinker, very recently single from a two and half year live-in relationship with my partner. My doctor and I have been exploring me starting medication. My resistance has always been the weight gain I've seen other people have (which has been a trigger for my addiction in the past) and other side effects. My doctor strongly suggests Stribild and mentioned Triumeq as an option, but because it's fairly new he warned against it. I am also open to taking more than one pill a day if it prevents the side effects and odd weight gains (especially in my neck and stomach). I am a 33 year old gay black man, non-smoker.

Response from Dr. Young

Hello and thanks for posting.

Today's HIV medications are not like those in past. Gone are the days of handful of pills, lots of side effects and toxicity. Indeed, just last week, the European Medical Agency dropped the warning about lipodystrophy from all HIV meds except for the dinosaurs AZT, d4T and ddI. A major lingering risk of development of fat changes is late HIV diagnosis and late initiation of treatment (ie. with low CD4 counts).

So, I'm in agreement with your care provider. HIV treatment is clearly and strongly recommended for all people living with HIV who are willing to be on medications. I'm a big fan of the shift in US guidelines towards integrase inhibitor-based treatments: they're more potent and better tolerated, resulting in fewer complications for patient and provider alike. Stribild and Triumeq are among those recommended regimens, and the two single pill regimens. Stribild has worked well, but does carry with it a number of potential drug-drug interactions and the risks of kidney and bone toxicity from tenofovir (will likely be less with version 2.0- coming soon). Triumeq is a also very reasonable and highly recommended first-line treatment option- it avoids the food requirement and drug interactions of Stribild. We have many patients on this integrase inhibitor-based treatment in our clinic and have had excellent experiences and tolerability.

Hope that's helpful, BY



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