My viral load bounces between 50 to 380. Genotype testing suggest virus is somewhat sensitive but not fully sensitive to Kaleta. Dr. suggested darunivar but I am allergic to sulfa based meds. I will be adding Issentress and Truvada. Should I explore other protease or keep on Kaletra. Can not take ziagen,virmune, or sustiva due to side effects. I had sever liver hepatoxcity that landed me in the hospital. I have experienced no side effects with Kaletra. CD4 count range is 380 to 510. I've been hiv since 1986. Dennis

Dear Dennis, I am assuming that your adherence with the medications is not an issue and that you are not missing doses.

The goal is to have 3 fully active drugs in the regimen. This can be achieved through adding up partly active drugs or just having 3 fully active individual drugs. If both Truvada (2 drugs) and Isentress are fully active, that leaves the 3rd agent. It would be important to know what you are using now with Kaletra? If you are already on Truvada than just adding Isentress to a non-suppressive regimen would not be a good idea. You would want to beef it up, with either another drug like etravirine or maraviroc (if your virus is susceptible). Changing to a more active PI (like darunavir or possibly tipranavir depending on the resistance level of your virus) while adding the active drug Isentress would give 3 fully active drugs, that would make sense. It is true that people with sulfa allergies are more likely to have reactions to darunavir. If that is a possibility you would not like to risk (perhaps your sulfa reaction was very severe) than looking at tipranavir or another/additional agent might be the best approach. Best of luck, Joe