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Addition of Isentress?
Dec 31, 2010

Hello, Thank you for the blog and this forum. I was wondering what your thoughts are on adding Isentress to a working treatment such as Atripla? I know you have to take it twice a day but are studies showing better results? I am currently on atripla for about 7 weeks now and VL is at 252 from 70K. Does Isentress show better results for CD4 increase? Please advise as I am wondering if I should change from Atripla to Isentress and Truvada.

Response from Dr. Frascino

Hi,

Regarding your first question about intensifying your current Atripla regimen by adding Isentress, I see no reason to consider any type of intensification based on your response to treatment so far. Within seven weeks of beginning Atripla, your viral load has plummeted from 70,000 to 252. This demonstrates virologic improvement. I would anticipate you will have some degree of immune reconstitution (rise in CD4 count) as the viral load continues to fall, hopefully to undetectable levels. As you have only been on treatment for a short time, I would advise waiting to ascertain how much benefit will ultimately be obtained from Atripla.

As to your second question, switching from Atripla to Isentress plus Truvada, these are both recommended regimens and there is no single best regimen for every person's unique situation. Both regimens have advantages and disadvantages that could sway the decision as to which would be best in an individual situation.

We have extensive experience with Atripla and it is the most convenient regimen to take; just one pill, once per day. However, there are some folks who shouldn't take Atripla: for instance women who might become pregnant, those with depression or significant mental health issues and folks who can't adjust to the side effects associated with efavirenz (a component of Atripla that can cause vivid dreams, sleep disturbance and other CNS symptoms). Isentress plus Truvada requires a higher pill count (three per day) and twice-daily dosing. It has fewer CNS side effects and cholesterol and triglyceride levels are generally lower with this regimen compared to Atripla.

The bottom line is that unless you are having difficulty tolerating Atripla, you should stay on that regimen and continue to monitor your progress immunologically (CD4 counts) and virologically (plasma viral load). Your HIV specialist physician will continue to guide you as to your best options for treatment and whether there is reason to consider modifying or switching your antiretroviral regimen.

Good luck.

Dr. Bob



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