Dear Dr. McGowan, About 2 months ago I was given a new cocktail by my physician. When I started this combination my VL was undetectable and my CD-4 cells were 310. The virus is resistent to most of the older type meds but now I am on: TMC125, Prezista (darunavir), Viread (Tenofovir), Isentress (Raltegravir), Epivir (Lamivudine) with finally Norvir as a booster. Earlier tests revealed that the virus is resistent to Epivir and Viread, but my doctor says that he is sure they "still do some good". I find that I am taking too many medicines, often a combination of 3 meds with a different approach suffices. I am taking 6! My doctor still advises me to continue with Viread and Epivir, but what do you think? Could I drop these two? Since I am on the above cocktail my VL has stayed undetectable and the CD-4 cells have gone up slightly. That is good of course, but I am so tired of taking so many meds that give side effects as well! Thank you for your answer and also for the good work you all do at The Body.

Greetings from ROB in Holland

Rob,

I am glad you are having improvement in your CD4 count and feeling well. It is not clear to me why your medications were changed if your viral load was undetectable. If it was to avoid a toxicity from a prior regimen, then that would be a good reason. Assuming it was to keep your virus suppressed long-term, the only way to answer your question about the need for all these pills would be to know how many "fully" active medications there are in your regimen. We would need 3 "fully" active meds to feel safe. Some of the medicines may be only partly active due to prior drug resistance in your virus. You may need 2 or 3 of these partly active medicines to count as one fully active medicine. Many people who have been on several different combinations will have virus that is partly resistant to nucleoside analog inhibitors and protease inhibitors. It is usually best to use fully active or new drugs but sometimes if there aren't 3 fully active drugs available we do have to build up the regimen with some partly active drugs. This may be what your doctor is doing. So viread and epivir may be included even though your virus is resistant if they are needed to make a total combination that is effective. One easy way to cut out at least one pill would be to suggest changing the viread and epivir to Truvada which is essentially equivalent (assuming your kidney function is normal). Also you can dissolve (disperse) the TMC125 in water to save swallowing the separate pills. I hope this helps.

Joe