Atripla + Isentress?

[Hellraiser]

Someone just told me they were on Atripla and Isentress.  I've never heard of anyone using both of these, in fact I've never heard of anyone using Atripla in combination with anything else.  Anyone been subscribed these together before?

[Rev. Moon]

It can happen.  I have read that this combination may be prescribed when the person is not reaching an undetectable level on Atripla alone (or on a treatment naive patient with a particularly high VL).

I'm sure that Inchlingblue or Newt will have better knowledge/details to share with you.

[Inchlingblue]

I'm sure that Inchlingblue or Newt will have better knowledge/details to share with you.

LOL

The reason they aren't usually prescribed is that Sustiva (efavirenz), which is part of Atripla, has been shown to lower the levels of Isentress in the blood.  I have heard of situations, as livebythemoon states, where someone is on Atripla and not becoming undetectable and so they add Isentress. Since the levels of virus we're talking about are quite low at this point, even a lower level of Isentress might be enough to knock it down to undetectable.

Do you know if that's the case with the person you heard about? Because I don't think it would make sense to add Isentress otherwise.

Sometimes Maraviroc is added to Atripla temorarily as a way to get viral load down faster and to raise CD4s, since Maraviroc has been shown to do this.

 

[Hellraiser]

No clue what the reasoning was.  I'm glad to hear about Maraviroc, I'll keep that in mind if my VL is uncooperative down the road.

[Inchlingblue]

No clue what the reasoning was.  I'm glad to hear about Maraviroc, I'll keep that in mind if my VL is uncooperative down the road.

There is a clinical trial looking to see if Maraviroc raises CD4s on individuals who are on a successful 3-drug regimen and undetectable. For that study, since it's only looking to see if Maraviroc raises CD4s, it's not essential for participants to have R5-tropic virus.

As far as lowering viral load with Maraviroc it would only work if the person has R5-tropic virus so you'd need a trofile assay in order to determine that first.

An effective 3-drug regimen should get you undetectable if there are no underlying resistance issues. Sometimes this can take a while if you start out with a very high viral load. As I'm sure you already know, adherence is key, especially during that period before one is undetectable.