Nov 14, 2006
I have a VL which is undetectable and CD4 which is 250 and have been on Sustiva/Combivir for 3 years. My doctor has recently switched me from this combo (after getting sick in Summer) to 1 x Kivexa(Abacavir 600mg and lamivudine(300mg) and Reyataz (2 x 200mg/day). A more experienced colleague recommends Retonivir (100mg) to boost this combo. However my doctor insists that since my VL is back below undetectable and my CD4 is steady between 250-350 there is no need to add the Retonivir yet. I have bad fatigue and painful joints (especially knees) but he insists things should get better. Is there any logical reasoning for his reluctance to go for what seems to be the "strongest" and recommended option? Help!
Response from Dr. Daar
Thank you for this excellent question.
In general I too prefer using Reyataz (atazanavir) boosted with ritonavir (norvir) because of the belief (not proven) that this regimen may be more potent and less susceptible to drug resistance developing. However, the down side to this is it requires the use of an additional medication, ritonavir, which can be associated with side effects. Consequently, if you are tolerating your current regimen and your viral load has been undetectable I am not sure there is a compelling reason to make the change at this time. It really ends up being a judgment call. The most important thing is that you continue to take the medications consistently and be followed by an expert provider on a regular basis.
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