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tivicay/ truvada vstriumeq orvonly tivicay

Jan 7, 2016

imredcthat have new study where hiv peoplectake only tivocay. i am on therapy 15 months (tivicay/trivada) no VL detectabile CD4 800. i have some papulosks on skin. i smoke much. generaly feel good but i am very slip all time 170cm 55 kg. I am 35 y and positive since 2012

Response from Dr. Young

Hello and thanks for posting.

There's been a lot of very interesting early clinical trials looking at novel treatment strategies with the integrase inhibitor dolutegravir (DTG, Tivivay, part of Triumeq). Intriguing studies from Europe and Argentina have looked at initial therapy with either 3TC/DTG or DTG monotherapy- both strategies with positive results, but IMHO, the 2 drug therapy looking a little better. There have also been studies looking at simplified maintenance therapy with DTG-based 2 drug regimens- similarly with very positive results.

OK, having said that, integrase inhibitor-based regimens are clearly superior to previous treatment regimens, indeed, the best treatments we've ever seen for HIV. There is an extensive literature of well-designed clinical trials and national treatment guidelines that endorse this collective scientific wisdom; all recommend three-drug regimens like the Tivicay/Truvada or Triumeq that you've mentioned (there are also three other integrase regimens recommended for initial treatment in US guidelines). I'd stick to where the extensive science lies and currently don't routinely recommend 2 drug or 1 drug treatment.

Your question isn't entirely clear on this, but if your "slip up" means that you're having difficulty with adherence, I'd recommend talking to your care provider or case manager (or scan these pages) for strategies to improve and reinforce your adherence to medications and clinic appointments. Perfection isn't required, but striving to hit the 90-95% target is important.

Moreover, this discussion is all about your long-term health, and you mention that you "smoke much". Tobacco is a bad thing for health, especially for people living with HIV, whose risks for cancer and emphysema seem to be higher than for negatives who smoke. Reduce your tobacco consumption if you can, quitting is even better. Again, talk to your care provider- dealing with tobacco doesn't have to happen by oneself, rather, there are support programs and medications that can really make a difference in motivated people.

The goal and the possibilities for HIV care today for a normal life span (that means 77 years or so for North American white men)- it's entirely possible for you- current medications can make this a reality, but adherence and tobacco can make this more challenging.

Hope that helps, be well, BY



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