HI, I AM FROM INDIA .MY FATHER IS 62 YEARS AND IS A CARDIAC PATEINT WITH DIABETES AND IS DIAGNOSED WITH HIV1 6 MONTHS BACK. WE STARTED THE TREATMENT WITH VIRADAY (CIPLA) (ATRIPLA) BUT AFTER 1.5 MONTHS OF MEDICATIONS SIDE EFFECTS WE REALISED IT WAS DUE TO VIRADAY SO WE CHANGED TO ON TENVIR EM (TRUVADA I.E TENOFOVIR AND EMTRICITABID) FOR ALMOST 3 MONTHS HIS CD 4 COUNTS AT BEGINNING WAS 267 VIRAL LOAD WAS 46,990 COPIES. AFTER 1.5 MONTHS OF ATRIPLA HIS CD4 WAS 218 AND VIRAL LOAD WAS 257 COPIES THEN WE SWITCHED TO TRUVADA I.E TENVIR EM AFTER 3 MONTHS OF IT HIS CD4 IS 459 AND VIRAL LOAD IS BELOW 20 COPIES. NOW THE DOCTOR IS SAYING IS TO ADD RALTEGRAVEER AS ITS NOT SUGGESTED TO BE ON 2 DRUGS . HE IS EMPHASIZING TO BE ON 3 DRUGS AND DOSAGE SHOULD RALTEGRAVEER IN MORNING AND TENVIR EM IN EVENING 12 HOURS GAP IS NECCESARY. I REQUEST TO SUGGEST ME WHAT SHOULD I DO AS ITS DIFFICULT TO FIND A GENUINE ADVICE HERE AND HAS VERY LIMITED DOCTORS IN THE CITY. THE ONLY HOPE IS THE ONLINE FORUM AND GENUINE FORUMS LIKE YOURS.

REGARDS AND THANKS IN ADVANCE. NAMS

Response from Dr. Young

Hello Nams and thanks for posting from India.

The use of Tenvir EM (tenofovir+emtricitabine) we call it Truvada here) alone is definitely suboptimal for the treatment of HIV; two drug therapy is not recommended as the risk of developing drug resistance is greater.

It’s not certain from your post if the <20 copy VL was obtained before or after the Tenvir EM alone- if it’s the former, I’d have concern about if the viral load was still suppressed prior to the addition of raltegravir. If it’s the later, this is excellent news- as it indicates that there was no emergence of virus or drug resistance.

Regarding the current regimen, Tenvir EM is dosed once daily, raltegravir twice daily (they can be taken together); and the timing of the second dose need not be exactly 12 hours apart; I recommend in the morning and evening only.