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Please answer it is urgent!!
Nov 11, 2017

I was diagnosed with acute HIV-1 infection in May 2017. My viral load was 10 million and my CD4 was 160. I started treatment with Genvoya and after five months of treatment, my viral load dropped to 99 copies and that of my partner to 220. My Cd4 is fluctuating between 312 and 356. My last cd4 percentage was 23.4 % in October 2017.

The problem is that my physician said that based on his experience, he is afraid that we will develop resistance because during the last 2 months the decrease in the viral load was too slow. My partners viral load decreased from 270 to 220 copies only and my viral load increased from 78 to 99 copies.

Knowing that in the first two months the decrease was dramatic (from 10 millions to 200 copies). He prescribed now etravirine with Genvoya to boost the treatment effect for the few coming months (as he said). Hobestly, I am afraid of taking Genvoya and etravirine together.

Please advise me if we can take them together and whether if it would be safe to stop etravirine when my physician recommends and to stay on Genvoya?

The medicine my physician wanted to add to genvoya was a sample he provided me with (in the intention of helping me) on which the following was written: Unlicenced medical product TMC125 100 mg Janssen R&D Ireland. Isnt it Etravirine?

I was afraid of taking it with genvoya and I didnt let my partner to take it too.

But the maximum of 6 months to get undetectable is stressing us especially that I have read many studies about the relation between reaching undetectable load in 6 months and the survival rateis that serious?

Response from Dr. Young

Hello and thanks for posting.

I'm not worried about your current viral load.

First off, the differences between the last two pairs of viral load tests are not clinically or biologically significant.

The main issue is that when one starts HIV treatment with very high viral loads (such as in the millions), it can take longer than usual to reach the undetectable threshold (usually below 20). If you consider that a typical "high" viral load is 100,000, reaching undetectable levels in the usual 3-6 months requires a 99.992% reduction. A similar fold-change (reflecting similar antiviral potency) from your initial 10 million viral load would yield a viral load of 2000.

So long as you're adherent to medications (and the dietary requiremenbt of Genvoya), it's patience, not additional medications is what is generally needed when starting with viral loads in the millions.

Moreover, a quick check of the very excellebnt, shows the potential for significant drug-drug interactions between Genvoya and etravirine- perhaps jeopardizing the potency of the medications.

So, I'd recommend not looking at the absolute viral load, but rather the percent (or log10) change in your viral load. My assessment is that things are going very well.

I hope that's helpful, BY

Response from Dr. Holodniy

I agree with Dr. Young's assessment and am not concerned.

Having unprotected sex while on PEP

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