I was diagnosed with hiv in 1995 and have been on drug cocktals since seroconversion. I have been discussing changing meds with my doctor on my last two visits. Currently I am taking 3tc, Stocrin and Videx and have been for about three years (a combination that theoretically should not be working, as I have shown resistance to one of the drugs. My viral load has been undetectable for several years, but my last two bloods showed detection, my CD4 count is about 370 and has been around there or a little higher for several years also. My doctor has suggested (by email at this stage) changing to Tenofovir, boosted Darunavir and Raltegravir. I have also discussed the want, not to take drugs that cause lipoatrophy, as I have had severe problems with this and had two Nufill (Scuptra) treatments in the past. Can you give me an opinion on this combination. Thanks.

The combination you are using has the attraction of being once a day, but unfortunately is not very forgiving once the virus starts to develop resistance. We say that it has a "low genetic barrier" to resistance because the virus only needs to make a couple of genetic switched (mutations) to render is ineffective. Since your viral load has become detectable and you already know that your virus has resistance to at least one of the 3 drugs in the cocktail it would be the right time to change. Also videx is a drug that can cause lipoatrophy, which is a major concern for you. The goal is to have 3 active drugs in your new regimen. The 3 drugs you mention tenofovir, boosted darunavir and raltegravir should be active drugs for you (you do not mention the previous treatments you took or if your virus had previously developed drug resistance - if your virus had protease inhibitor resistance that may effect the response to darunavir, likewise there may be tenofovir resistance based on prior treatments. These would have to be assessed by your provider). The new coctail also may have a low relative likelihood of causing lipodystrophy.

Good luck,

Joe