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Should We Mess with Success?

Should the regimens be changed for three patients who have undetectable viral loads and normal or near-normal CD4-cell counts and are tolerating their treatments well?

Three patients present for regular outpatient care. As described below, all have stable HIV disease, with undetectable viral loads and normal or near-normal CD4-cell counts. None has experienced virologic failure on any treatment or has a known history of drug resistance. All are without adverse effects on their current regimens.

This week, we ask for your opinion. Next week, we will present the opinions of three experts.

Patient 1 is a 50-year-old man who has been taking abacavir, 3TC, and efavirenz since 2001. He has no renal disease but does have hyperlipidemia (well controlled with atorvastatin). His father died of a myocardial infarction at age 48.

Patient 2 is a 63-year-old man who has been taking efavirenz and lopinavir/ritonavir since 2002. While on an earlier regimen — d4T, 3TC, and indinavir — he developed a severe neuropathy, which left him with residual numbness and tingling in his feet. He now needs to go on an inhaled corticosteroid to treat increasingly refractory asthma.

Patient 3 is a 35-year-old woman who has been taking abacavir, 3TC, and twice-daily ritonavir-boosted fosamprenavir since starting this regimen in a clinical trial 5 years ago. Each week, she misses about two afternoon doses of the boosted fosamprenavir.

TELL US WHAT YOU WOULD DO

For each patient, would you switch or alter the current regimen? If yes, to what — and why? Submit your comments below.

Note: The expert opinions have now been published.

Published in AIDS Clinical Care June 29, 2009

Reader Remarks:

Read all Reader Remarks on this article

• patients,1,2,3
  Alvin M., 30 Jun 2009 4:56 PM EST
  patient (1) good therapy leave alone. patient (2) start with lyrica 75mg b.i.d.< to 500 to 600 mg as tolerated.start... [more]
• Should We Mess with Success?
  Helen C. Azzam, 30 Jun 2009 4:56 PM EST
  Patient 1: Given the risk of MI with abacavir and this patient's risk factors (lipids, famHx), I would change the... [more]
• Don"t fix what isn't broken.
  William J. DeMedio, private practice, 30 Jun 2009 4:56 PM EST
  The current goal in HIV therapy is to eliminate viral load, minimize disease progression, prevent opportunistic infections, and minimize antiretroviral... [more]
• Changing treatments
  Antoine. M Donot, Belgian prison, 30 Jun 2009 4:56 PM EST
  Pt 1: CV risk, so I would recommend switching ABC to TDF. PT 2 : no change. PT 3: Because... [more]
• Changing treatment
  Alastair Miller, Royal Liverpool University Hospital, Liverpool L22 8QP, 2 Jul 2009 12:47 PM EST
  Case 1 - need to know more about him to make a good CV risk assessment but at 50 it... [more]
• Three patients stable on ARV
  Dr. J.J. Ongole, Specialist; Head, HIV and TB Programs, Piet Retief, South Africa, 2 Jul 2009 1:40 PM EST
  The three patients are clinically stable on treatment with full viral load suppression and good immune response measured by CD4... [more]