Question
Will this dual combination work given the drug resistance results?
4 July 2016. Related: All topics, Changing treatment, Resistance, Starting treatment.
Hi. I was diagnosed in April 2016 with a VL of 6,300 and CD4 of 490.
I went on Atripla in early May 2016, when my VL was 23,000. My genotypic resistance test came back with low – to – intermediate resistance to NRTIs. My doctor shifted me to dolutegravir + darunavir + ritonavir starting end May 2016.
She said this is now the recommendation for NRTI-resistant patients in the UK. Is this correct? What is the likely efficacy of the dual therapy regimen I am on? How does it compare to Atripla – like triple therapy?
What is the likelihood of having developed NNRTI resistance as well, given that I was on one month of efavirenz – mono therapy ?
Answer
Thanks for posting these questions – all very good questions.
I am sorry to the late reply as there was a change of staff at i-Base and I am double-checking that a few questions were not missed.
Firstly, it is good that you are already on treatment (ART). Although finding out you are positive can be tough, ART prevents any further damage from HIV and it makes it easier to get on with life again.
The short time that you spent on Atripla is unlikely to have led to resistance to NNRTIs. This is because your viral load was very low and the NRTIs would still have been working, even if not fully. It is a good question to ask though.
Interpreting drug resistance tests is easier with the exact mutations that were found. I can go into more detail if you have these mutations.
Your new treatment with dolutegravir and boosted darunavir will easily be strong enough to control HIV.
In the future, results of ongoing studies might even let you use dolutegravir with lamivudine (3TC) – even if you have resistance to this NRTI.
Your doctor is giving you good infomration and is using combinations recommended in UK guidelines.
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