|RE: Selzentry with thorazine (May 23,2013)
Jun 14, 2013
Dear Dr. Thanks so much for answering my questions. My son's virus is not undetectable on the complera. It hasn't been from the start. He is a long term survivor. We chose complera to reduce side effects of diarrhea and nervousness from the PI's and other drugs. The dna trofile test for selzentry came back, and the selzentry is suitable for his type of virus. I am still hestitating about it because of the high dose of thorazine he takes. You did say that if he is resistant to the rilpivirine in complera, the etravirine may be an option. We are waiting for the resistance test to come back. I'm praying the truvada will still be a good drug for him because it has the least side effects. Depending on what the resistance test shows, my question to you is this....Which would be a more suitable regimen for him, the selzentry with the truvada or the etravirine with truvada. In your last letter I don't think you meant we should add the etravirine to the complera. We are looking for a regimen that will give him quality to life without the diarrhea and nervous problems. To your knowledge, which regimen do you think would be more appropriate? His cd4 cells went down to 450 from 600 in the last month, and we don't know the viral load yet. Thank you!
Response from Dr. Henry
etravirine generally has higher barrier to resistance than the rilpivirine but its activity can be predicted by a genotypic analysis of the virus recovered while on the Complera. Data is limited regarding use of high dose Thorazine with either maraviroc or etravirine but I would try if needed with close observation. If resistance is present then often would need to use a boosted PI in the regimen unfortunately. Raltegravir is another good option to make sure there is at least 2 active drugs if that has not been used yet (an integrase inhibitor so not an PI). KH
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