Question

Hi doctor, I'm from Italy and I've been on therapy since late 2009. At first I started with Sustiva and Truvada but having had a skin rush after a couple of weeks my doc switch to two Reyataz and one Kivexa a day. I'm still on this therapy and everything is fine, my labs are great and I never had any problem. Now my new doctor has suggested to me to skip to a lighter therapy adding Norvir so I can have just one pill of Reyataz and the regular Kivexa or skipping to Triumeq. Since I'm really ok with the therapy I'm in, I wanted to ask a second opinion and who better than you? bye!

Answer

Hello and thank for posting from Italy.

While either treatment switch approach your doctor has discussed are generally reasonable, current US treatment guidelines would favor the use of Triumeq (abacavir, 3TC, dolutegravir) for initial (ie., first-line treatment). I wouldn't view Triumeq as lighter (whatever that actually means), but it's certainly very well tolerated and with fewer pills than the Reyataz regimen.

The treatment guidelines and clinical trials data generally suggest the superiority of integrase inhibitor-based treatments over the use of the older standards (protease inhibitors like Reyataz, or NNRTIs like the efavirenz in Atripla). Indeed, in a recently presented all-women's study called
ARIA, Triumeq performed superior to a regimen of Truvada + Novir-boosted Reyataz.

I hope that this is helpful, BY