Should You Change a Treatment Regimen That's Working? An HIV Doc Responds

Joel Gallant, M.D., M.P.H.
Joel Gallant, M.D., M.P.H.

We currently have an abundance of HIV treatment regimens to choose from that can keep your viral load undetectable. For those who are doing well with a treatment regimen and have achieved an undetectable viral load, you might think, "Don't fix what's not broken." But what happens if your doctor recommends a change in your regimen, such as taking a break from one or more drugs?

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 partial drug holidays and switching meds.

On May 8, 2016, an anonymous user asked about his boyfriend, who has been taking Prezista (darunavir) + Norvir (ritonavir) + Viread (tenofovir) since 2012 and has had an undetectable viral load since then. At the boyfriend's last doctor's visit, the doctor told him to stop taking Viread one month before his next blood test. The questioner asks if his boyfriend should follow this recommendation, saying, "Is this safe for him?"

Gallant answered (with supplementary drug names provided):

This is a somewhat experimental approach. Switching to Prezista + Norvir alone has been studied, and although it works most of the time, it's not a recommended approach in any guidelines that I'm aware of. Also, I assume he's also taking Emtriva (emtricitabine, FTC) or Epivir (lamivudine, 3TC) along with Viread.

If he were experiencing Viread toxicity, it would make more sense to continue one of those drugs rather than just take Prezista + Norvir alone ... although that's not a recommended strategy either.

Finally, Viread toxicity can be dealt with by switching to either Ziagen (abacavir) or tenofovir alafenamide (TAF).

If I were your boyfriend, I'd want to understand the doctor's reason for proposing this switch before agreeing to it.

Have you experienced a similar situation of questioning whether or not to switch a regimen you're doing well on? What did or would you do? Discuss in the comments section below.

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.