The Best HIV medication combination
Mar 24, 2017
Doc, I understand there are a lot of variables, but if you were HIV positive and didn't have any other health issues, which medication would you take? I read an article recently in which an HIV doctor said in his opinion the best overall combo was Descovy and Tivicay. I take Descovy and Isentress. I don't mind taking three pills and I am reluctant to change if this combination is working.
Response from Dr. Young
Hello and thanks for posting.
The regimen that your doctor has offered to you is one of a very limited set of regimens recommended in the most current US Department of Health and Human Services treatment guidelines. It's also entirely relevant that your current regimen is also among this highly regarded list.
While the combination of Descovy (TAF/FTC) and the HIV integrase inhibitor Tivicay (dolutegravir/DTG) isn't a single pill, if taking two small pills isn't an issue for you (and IMO, for most patients, it's not), then it's widely considered as among the best three drug combination. This regimen is most often very, very well tolerated, can be taken without regard to food and has very few drug drug interactions. A Tivicay-based regimen is also available as a single pill with abacavir and 3TC (called Triumeq), though because of the presence of abacavir, requires a genetic blood test to make sure that one's not at risk of having an allergic reaction.
There are also other recommended regimens that include the two other integrase inhibitors (raltegravir (Isentress) and elvitegravir) and the lone recommended boosted protease inhibitor darunavir (Prezista/Prezcobix). Raltegravir is very well tolerated, though currently requires twice-daily dosing (a once-daily formulation is likely to be FDA-approved soon), and elvitegravir is available in two different single tablet regimens (Stribild and Genvoya), but requires pharmacologic boosting (with many potential drug-drug interactions) and must be taken with food.
Your current regimen (albeit with the older Truvada pairing) and proposed regimens were tested head-to-head in the Single clinical trial. This trial showed that the two regimens were nearly identical to one another in viral suppression and side effects. Hence, the principle advantage of the proposed switch is going from twice- to once-daily dosing. If you've been able to keep up with the adherence and have maintained a suppressed viral load, there might not be any great differences to you. On the other hand, if missing the second Isentress dose has been a problem, the switch might be helpful (noting that that once-daily formulation of Isentress is just around the corner).
So in the end, what's best for you? You'll have to decide in discussion with your healthcare provider.
Either way, stay or switch, you'll be on a very highly regarded, highly effective and well-tolerated option.
Be well, BY
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