Question
Why does my doctor want to switch me from Combivir…?
10 August 2011. Related: All topics, Changing treatment, Side effects.
My viral load has increased from undetectable to 70 and is now 80. What is really going on?
My provider wants to take me off Combivir and put me on Truvada along with Reyataz (atazanavir) and Norvir (ritonavir).
Answer
Hi
Your question is about two things that I think are different.
One is about your viral load results and the other is about changing treatment.
Without knowing more about earlier viral load and CD4 results, and your current drugs, I can only give general information. This is because your viral load results need to be interpreted with earlier results.
For example, have you only recently started treatment and only have these two results? Or perhaps you were undetectable before and these are two blips?
In general, viral load tests are not very sensitive at low levels. This means that it would be unusual to change treatment just because of two results under 100. Most doctors would want viral load confirmed at least about 200 before making a treatment change. This year the US guidelines even suggested that any results under 200 could be considered undetectable.
Although the treatment change may be related to the viral load, there may be other reasons your doctor is suggesting these new drug.
Combivir (AZT/3TC) is rarely used in the UK and guideline have recommended Truvada (tenofovr/FTC) as an alternative for many years.
Atazanavir/ritonavir are also good drugs to include with Truvada because they are all taken once-daily. This might be the reason your doctor is switching your other meds too.
These are important questions about your health. You need to understand why your meds have been changed. Please ask you doctor to explain the decisions so that you are involved in this aspect of your care, and get back to us if you have questions after this.
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