{"id":408,"date":"2009-05-19T20:40:28","date_gmt":"2009-05-20T01:40:28","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=408"},"modified":"2015-06-04T15:30:49","modified_gmt":"2015-06-04T19:30:49","slug":"time-for-a-switch-room-for-debate","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/time-for-a-switch-room-for-debate\/2009\/05\/19\/","title":{"rendered":"Time for a Switch? Room for Debate"},"content":{"rendered":"

\"\"<\/a>With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine:\u00a0 Viral load undetectable, CD4 stable.<\/p>\n

But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d have nothing to do, the other said he NEVER <\/strong>changed a regimen that was working unless he absolutely had to.<\/p>\n

Who’s right?\u00a0 Both of them, of course.\u00a0 The regimen might improve in convenience, tolerability, safety, etc, but new side effects could also occur, as well as virologic failure.<\/p>\n

So consider these virologically suppressed, clinically stable patients (all recently seen) — would you switch?<\/p>\n

    \n
  1. 50 year old man on ABC\/3TC, EFV since 2000.\u00a0 No renal disease.\u00a0 Hyperlipidemia, on atorvastatin 80 mg a day.\u00a0 Father died of an MI age 48.<\/li>\n
  2. 63 year old man, on EFV + LPV\/r for years; past history of neuropathy on d4T and 3TC.\u00a0 Needs to go on inhaled steroids (preferably fluticasone) to help manage increasingly refractory asthma.<\/li>\n
  3. 35 year old woman, on TDF\/FTC, FPV\/r BID — doing ok but missing some PM doses.<\/li>\n<\/ol>\n

    Keep in mind, all are doing fine — would you switch?\u00a0 If so, to what?\u00a0 Thanks in advance* for the consult.<\/p>\n

    (*ahem.)<\/p>\n","protected":false},"excerpt":{"rendered":"

    With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine:\u00a0 Viral load undetectable, CD4 stable. But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4,5,8],"tags":[],"class_list":["post-408","post","type-post","status-publish","format-standard","hentry","category-antiretroviral-rounds","category-hiv","category-infectious-diseases","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/408","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=408"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/408\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}