An HIV Doctor Discusses When Switching HIV Meds Is a Good Idea or a Bad Idea
Regimens can change over time. Sometimes, switching regimens can be scary. There are many factors to consider when deciding whether to switch regimens. On his personal Tumblr, Joel Gallant, M.D., M.P.H., an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions from people living with HIV who are concerned about a number of issues, including HIV drug resistance. Recently, he answered two questions about switching drugs and addressed the possibility of drug resistance.
On May 11, 2015, an anonymous user asked:
During today's doctor visit, I agreed to switch Triumeq triple therapy to dolutegravir mono therapy. Not that there is any real reason but my doctor says I only have everything to gain and that in the unlikely event of a "blip" I can always revert to Triumeq.
You're turning yourself into a guinea pig by using a completely untested strategy. Everything to gain? What exactly do you have to gain? You said you have "no real reason," so I assume you're having no problems with Triumeq. Nothing to lose? While it's true that we haven't yet seen resistance to dolutegravir, if we ever do see it, it will be in people who do what you're doing, and if you develop resistance it will then be too late to switch to Triumeq.
In short, I strongly disagree with this plan. We conduct clinical trials for a reason: to find out whether experimental treatments are safe and effective in large numbers of people under controlled and carefully monitored conditions.
On May 12, 2015, an anonymous user asked:
I've been on Isentress and Kivexa for a few years but would really like to switch to Triumeq. I have a meeting with a consultant in a few weeks and I want to make a case to him for switching. The convenience and simplification of a single pill regimen is my main driver but would you add anything else to support my case for change? I have also missed my second Isentress pill on a few occasions.
This kind of a switch is a "no-brainer" that few HIV providers would object to, as long as it's available where you live. You're already on two of the components of Triumeq, so you'd simply be switching from raltegravir to dolutegravir. There's no real downside, and the advantages are that you'll be switching to a drug with a stronger barrier to resistance, and you'll be less likely to miss doses.
Do you have any questions about switching regimens? Visit our "Ask the Experts" forum on choosing your meds.
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.