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HIV Drug ResistanceHIV Drug Resistance
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epzicom reyataz
Jul 10, 2007


After 15 yrs of sitting on the side-line, I have initiated therapy, last week (epzicom reyataz). My T- Cells are @ 300 and VL has always been between 5K - 16K. My Doctor suggested that the un-boosted epzicom reyataz combo made sense due to my relatively low VL. I fully anticipate being 100% compliant. Does the un-boosted regimen sound reasonable? Or should I be jumping on the Norvir train?

PS, I was genotype tested in advance of starting the epzicom (no concerns there) and I have experienced no side-effects whatsoever so far.

Thanks in advance for your response.

Warm Regards,


Response from Dr. Sherer

My own bias is to always use boosted atazanavir, even in a setting like this. If I were to use unboosted atazanavir, you would be an appropriate candidate, i.e. with a low viral load and higher CD4 cells. My reasons are that the drug levels achieved without boosting are quite close to the minimal level needed for optimal viral load control, and there is quite a bit of inter-patient variability in drug levels. Then add to that the possibility of drug interactions, particularly the possiblity that you might use PPAR-gamma inhibitors like omeprazole or H2 blockers like ranitidine, which reduce stomach acid and impair the absorption of atazanavir (note that this can also lower BOOSTED atazanvir to unacceptably low drug levels), and I prefer the initial trial with this drug to be in the presence of ritonavir boosting.

A small percent - perhaps 2-3% - of people can't tolerate ritonavir, even at low doses, and if you fell into that group, I would try a different regimen.

I would talk to your doctor about these issues. If you remain on atazanavir alone, I would be mindful of the possible interaction with agents that lower stomach acid and avoid them.

Do I understand it correctly?
drug resistance - when does it occur?

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