chosing the best available regimen

Question

I ALWAYS like to be on the best latest regimen.,,, ( lucky to have insurance that pays ok) Doing well on triumeq... ( <20 cd4 780 37%, stable for many years) Started d4t/zerit/viracept in 1995? made changes as times changed, .. atripla. stribild, tivicay and ??? and now triumeq.. I read a post from dr joel gallant from late 2016 that said when he talks with hiv specialists. the regimen that they would take if they needed one , is tivicay with f/taf. thoughts on this regimen.. ? to go from one pill at bedtime ( triumeq) to 2 pills at bedtime is not an issue for me.. and as we age.. every side effect should be considered.. I'm 57.. thanks.

Answer

Hello and thanks for posting.

Today's HIV treatments are a vast improvement over earlier regimens, and many of today's HIV integrase ihhibitor regimens have shown superiority over previously vaulted regimens, like Atripla.

Dolutegravir-containing regimens such as your dolutegravir/abacavir/3TC (Triumeq) and Dr. Gallant's "favorite" dolutegravir + FTC/TAF (Descovy) are 5 of the just 6 recommended combinations in current US DHHS treatment guidelines.. Since you're already on Triumeq, we can assume that you've already passed the main requirement for Trimeq use, namely the HLA B5701 genetic test. There are differences among each, but I'd have a difficult time giving you an evidence-based reason why Tivicay+Descovy is better than Triumeq. The core agent in both is dolutegravir, offering excellent tolerability/potency/safety, drug resistance profile, and lack of drug-drug interactions.

If anything, I'd be following the developing story of the use of dolutegravir two drug regimens (either with rilpivirine or 3TC) with interest. Both new combos portend greater differences than the Triumeq or Tivicay+Descovy switch that you've listed, and clinical trials results so far have been strongly affirmative. Additionally, long-acting once-a-month injectable two drug regimens with a dolutegravir cousin (cabotegravir) are moving along.

So, if you were my patient and already successful on a DHHS-recommended regimen, I'd likely not strongly advocate switching, unless the switch offered you clear cut improvement.

I hope that's helpful, BY