Adherence and HIV Resistance Risk With Stribild
Is HIV resistance something you have to worry about? With antiretrovirals being stronger than ever and keeping people living with HIV (PLWHA) living longer than ever, resistance is a topic that worries a lot of people. We know meds are effective -- and we want to make sure that they will stay effective as long as possible. On his personal Tumblr ("Ask Dr. Joel"), Joel Gallant, M.D., M.P.H., an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions, often in a dry, sarcastic manner, from people -- anonymous or otherwise -- regarding a host of topics, and adherence and resistance are common topics. Here's how he handled one question about resistance and Stribild.
On July 23, 2014, one anonymous user asked:
My doctor says that resistance develops much faster and easier with Stribild than with other treatments such as Truvada / Prezista / Norvir -- which he said is fairly "forgiving" if you start and stop and start and stop (which I do admit to having a history of) but that you CANNOT do that on Stribild EVER. He said two or three missed doses and I'm screwed. WHAT?? Is this True? Or is he just trying to discourage and influence my recent desire / request to switch. Just sounds like I'm being fed a line of BS.
Your doctor may be a little more alarmist than I would be, but it's not B.S. People who start and stop meds are better off on a boosted protease inhibitor (PI) than an integrase inhibitor. Now matter how much you screw up, it's really hard to develop resistance to PIs, which also protect you against nucleoside resistance. I generally treat my less adherent patients with the very regimen you're taking now.
It's not easy to get resistance to Stribild either -- you won't get it from missing 2 or 3 doses -- but it happens, generally in people who are poorly adherent or who interrupt therapy. As integrase inhibitors go, Tivicay is probably more forgiving than Stribild in terms of adherence and resistance, but we still don't know whether it's as good as a PI from that standpoint.
As I see it, you have two choices: (1) Stick with your current regimen, or (2) stop being a non-adherent doofus so you can safely make the switch.
Joel Gallant, M.D., M.P.H., is the associate medical director of specialty services at Southwest CARE Center in New Mexico. You can ask him a question directly on his Tumblr page, Ask Dr. Joel.