May 23, 2013
IM HIV POSITIVE SICE 1-15-13 I WAS DIAGNOSED WITH AIDS - CRYPTOCOCCAL MENINGITIS. CD4 WAS 20' VL 34.000. I WAS STARTED WITH KALETRA AND TRUVADA AND BECAUSE OF SEVERE GI SIDE EFFECTS, KLETRA WAS CHANGE TO RALTEGRAVIR. NOW IM ON RALTEGRAVIR+TRUVADA. CD4 163, VL 380 (IN 4 MONTH OF TREATMENT) RESISTENCE TEST WAS TAKEN ONLY 3 MONTH I BEGUN TREATMENT (I WAS TREATED IN NON AIDS CENTER). MY DOC. THING THS IS PRIMARY RESISTENCE. HE DECIDED TO CONTIUE WITH TRUVADA (RESISTENCE TO EMTRICITABINE, LAMIVUDINE) ANS ISENTRESS ADDING TO THE REGIMEN MARAVIROC. DO YOU THING IT IS A GOOD CHOICE? WHAT WOULD YOU DO IN SUCH CASE? WHICH HIV MEDICATION CAN NOT BE GIVEN IN SUCH CONTEXT OF THAT MUTATION. IM AFFRAID THAT TENOFOVIR WILL CAUSE A PRESSUE RESISTENCE CAUSING A MORE SEVERE MUTATIONS LIKE K64 R . PLEASE ADVISE ME! THANK YOU VERY MUCH FOR YOUR AVIALBILITY FOR US!
Response from Dr. Henry
There is not as much experience using maraviroc in situations such as yours compared to a boosted protease inhibitor based regimen. Was a Trofile assay done look f?r CCR5 vs R4 virus to determine likelihood of a response to maravirox. I would generally use a boosated protease inhibitor and raltegravir plus likely continue the Truvada if only the M184V mutation detected so far. Recommend dicussing with local HIV specialist reviewing all data available. KH
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