CH-CH-CHANGES

TO SWITCH OR NOT TO SWITCH

THESE DAYS, THERE ARE MORE SAFE AND EFFECTIVE OPTIONS THAN EVER TO TREAT HIV. HERE’S HOW TO KNOW WHEN A CHANGE IN YOUR REGIMEN MIGHT DO YOU GOOD.

BY JACOB ANDERSON-MINSHALL AND DESIRÉE GUERRERO

If your HIV medication is working well for you without any significant side effects or issues, there may be no need to consider switching up your regimen. However, if you’ve ever considered changing meds, it is now well documented that it is safe — and sometimes highly advantageous — to switch from one HIV treatment to another. But with more options available than ever, it can be challenging to try to figure out which regimen might be right for you — which is why it’s important to discuss it with your doctor.

If you are already undetectable, you can switch without risking your viral suppression. If you are struggling to take your meds as prescribed, facing daunting side effects, dealing with a comorbidity (like high cholesterol or liver disease), experiencing certain health concerns (say, fragility as you age), or have changing lifestyle issues (such as unusual work hours), then talking to your doctor about reevaluating your medications can be the right choice. They’ll most likely be able to fine-tune your regimen just for you, which could in turn greatly improve your quality of life.

Read on for our tips to know when it may be a good time to discuss switching with your doc (and don’t forgot to bring our annual Treatment Guide with you!):

1IF YOU ARE WORRIED ABOUT DRUG RESISTANCE. Some drugs offer more protection against HIV developing resistance. For example, the ODIN trial found that darunavir (a component of both Prezista and Prezcobix) stops the virus from multiplying and mutating. (Symtuza, which also contains darunavir, offers a high barrier to resistance but isn’t recommended in most cases for those already on treatment.) The fact that you’ve developed a resistance to one drug, or one or more classes of drugs, doesn’t mean that other HIV meds won’t work for you. For example, Trogarzo (ibalizumab), a long-acting injectable, fights multidrug-resistant HIV when added to a previously failing antiretroviral regimen. 2IF YOU WANT TO REDUCE THE NUMBER OF DRUGS YOU TAKE. Although three-drug regimens were once considered essential in preventing the development of HIV drug resistance, new two-drug regimens have proven to be just as effective. Their advantages include fewer side effects, and a reduction in toxicity associated with long-term drug therapies. Juluca (dolutegravir/rilpivirine) was the first two-drug regimen approved by the Food and Drug Administration. In 2020, the DUALIS study demonstrated that dolutegravir and boosted darunavir are as effective as a three-med regimen. 3IF YOU TAKE YOUR MEDS WITHOUT FOOD. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (protein or a hearty meal, rather than a snack). So if you’re the kind of person who either doesn’t eat that way or forgets your meds until later, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/ emtricitabine/tenofovir alafenamide) or Triumeq (dolutegravir/abacavir/lamivudine). 4IF YOU ALSO HAVE HEPATITIS C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but some HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously. 5IF YOU ARE PREGNANT. “When a woman living with HIV is expecting, she can be confident that the same antiretroviral therapy she takes every day to protect her own health also helps protects her future child from acquiring HIV,” Anthony S. Fauci, chief medical adviser to President Biden, reiterated at last year’s Conference on Retroviruses and Opportunistic Infections. “Findings from the VESTED study suggest that a drug regimen containing dolutegravir provides the safest, most effective HIV treatment available during this critical time for women and their infants.”

6IF YOU HAVE KIDNEY OR LIVER PROBLEMS. Tenofovir disoproxil fumarate (TDF, brand name Viread, and a component of drugs including Atripla, Complera, Delstrigo, and Stribild) has been linked to kidney problems in susceptible individuals, so those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), such as Genvoya, Odefsey, or Descovy. It should be noted that Juluca, a single-drug regimen that overall promises fewer side effects, has seen some users develop new or worse liver problems. 7IF YOU CAN’T DEAL WITH THE SIDE EFFECTS. Every medication has potential side effects — some minor, some life-threatening. Not everyone taking a certain medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are negatively affecting your daily life. 8IF YOU ARE AFRICAN-AMERICAN. A sad truth is that few drug trials test the impact of a treatment on people of color, especially women. That’s what makes 2020’s BRAAVE study so remarkable. It involved 495 selfidentified Black or African-American HIV-positive people (32 percent were cisgender women) who switched to Biktarvy from a variety of regimens. Virtually all of those who switched maintained viral suppression. 9IF YOU ARE CONCERNED ABOUT GAINING WEIGHT. At CROI 2021, researchers shared more data confirming that some HIV drugs lead to weight gain. Taking integrase inhibitors (dolutegravir or raltegravir) was previously associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. Recent studies indicate, however, that tenofovir alafenamide, an NRTI, is linked to weight gain. Weight gain can also raise your risks of diabetes and heart disease, so if these are concerns of yours, remember to discuss them with your doctor.