Question

Is this a blip on Truvada and nevirapine?

15 August 2011. Related: Adherence, All topics, CD4 and viral load.

Hi Guys, as many people have said before – thanks for the great support that you provide to HIV+ people ! My main question is how strong / reliable a combination is Truvada & nevirapine? I have been diagnosed HIV+ for a year and a half now and went on this combo straight away as my CD4 count was 170. My viral load came down gradually however it took 8 months for it to become undetectable. My lowest reading of VL was 47. I have just been requested back to the lab for VL re-test as my recent results were VL 70 ! My adherence is perfect although I do take my meds sometimes on an empty stomach. Is this likely to be a ‘blip’ ?

I am quite worried as I have to wait 2 weeks to get the re-test results….

Answer

Answer: Simon Collins

Truvada plus nevirapine is a good combination with the main caution being a small chance of rash or lab results of liver tests when you first start. If you have no problems during the first couple of months it is generally a very easy combination to take.

If your viral load has been undetectable for the last 10 months (a year and a half minus 8 months) and been good with adherence, this is likely to be a blip. Viral load tests are not so sensitive close to the cut-off levels and US guidelines now suggest anything less than 200 is probably the same as an undetectable result.  It is good that you clinic has check this again but based on your circumstance this is not something to worry about until you know the results.

Tenofovir (one of the drugs in Truvada) is recommended to be taken with food in Europe and with or without food in the US. Food increases tenofovir levels by about 30% but having been undetectbale for so long is unlikely to be the reason for this blip.

Nevirapine can be taken with or without food.