Add etravirine to Genvoya – NOT RECOMMENDED
I was diagnosed with acute HIV-1 infection in May 2017. My viral load was 10 million and my CD4 was 160. I started treatment with Genvoya and after five months of treatment, my viral load dropped to 99 copies and that of my partner to 220. My Cd4 is now 312.
The problem is that my physician said that he is afraid that we will develop resistance because during the last 2 months the decrease in the viral load was too slow. My partner’s viral load decreased from 270 to 220 copies only and my viral load increased from 78 to 99 copies.
Knowing that in the first two months the decrease was dramatic (from 10 millions to 200 copies) He prescribed etravirine with Genvoya to boost the treatment effect for the few coming months. I am afraid of taking Genvoya and etravirine together.
Please advise me if I can take them together and whether if it would be safe to stop etravirine when my physician recommends and to stay on Genvoya?
Thanks for emailing your question – and I hope you get to read this online reply.
First, and even without more details, please tell your doctor that there is a serious drug interaction between Genvoya and etravirine that means these drugs should not be used together.
Etravirine can reduce the booster in Genvoya and this in turn would reduce drug levels of elvitegravir (one of the main active drugs).
Please ask your doctor to check this online at:
Secondly, it is very common that starting with a very high viral load often takes longer that 3-6 months to reach undetectable levels. It is strange that you almost got this low though, but it is probably better to keep on your current combination and just check viral load more frequently – ie every month.
There is technically no difference between a viral load of 78 and 99 copies/mL and the test often is less sensitive at these levels.
Also, are you taking Genvoya with food? Even with the booster in Genvoya, food is still essential to get to high enough drug levels. Taking it with food now could be enough to get you to undetectable, if you were not always taking it with food before.
If your doctor is really worried abut drug resistance, or if the next viral load test in much higher (ie above 200 copies/mL), you could change to an anew combination where drug resistance is more difficult. This would mean using a combination based on dolutegravir rather than elvitegravir.
Depending on high high viral load becomes, this might mean using dolutegravir as a twice-daily dose (rather than once-daily).
Definitely do not start taking the etravirine though – and please let us know what you decide to do.
How is your partner doing too?