Jul 9, 2009
I have had HIV/Aids 25yrs, I have been on & become resistant to most meds. I have been on Isentress/Truvada regimen for a couple yrs now & recently went through an "on & off" regimen due to recent move to different state. I have had nothing but infections since my "move/on-off" situation, does this mean resistance? Thanks Dave-Fla.
Response from Dr. Sherer
Unfortunately, it might, and you should get to an HIV specialist with experience in the management of treatment experienced patients as soon as possible to answer this question and make the best possible choices for your next actions.
Although Isentress gained a reputation as a powerful drug in the early clinical trials, and deservedly so, we have learned that it is susceptible to resistance to a greater degree than the boosted PIs, for example, and to a lesser degree than the NNRTIs.
I will pose a few questions for you and your doctor to consider, because the information you have provided is limited.
- What were your past ART regimens, and the response to those regimens? - What were the results of your previous resistance tests, and on what basis did your current physician prescribe the regimen of Isentress and Truvada? - What past side effects have you had with previous regimens, and what other medications are you taking now?
I would also focus on this recent experience of 'on and off' dosing. Did this result simply from having to move and the lack of a continuous drug supply, or were there other factors involved? It will be essential for you and your next doctor to work out your next regimen and the means for you to adhere fully to it, as you may be down to your last options with ART.
You can ask your doctor about other new drugs that might be useful for you, including darunavir or tipranavir (new PIs), etravirine (Intelence, the 2nd generation NNRTI), maraviroc (Selzentry, the new CCR5 entry inhibitor), and enfuvirtide (Fuzeon), the first entry inhibitor that requires twice daily subcutaneous injections.
In sum, I urge you to get to an HIV expert ASAP, repeat a viral load, CD4 cell count, resistance test, and other baseline labs, and work out your next best treatment strategy. In addition, you and your doctor may need to take the time to diagnose and treat all of the infections that you refer to. -
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