Having been undetectable on HIV meds since shortly after my diagnosis in 2001, I never thought I’d be anything else. As a longtime HIV reporter, I’ve written countless stories about people developing resistance and becoming detectable, for reasons spanning from flubbing the taking of their own meds to simply having amassed so much prior resistance that no new med addition could seem to suppress them. That would never happen to me, I told myself. I even gamed the system for several years: working with my doctor, I managed to downscale my longtime regimen—Viramune plus Truvada—to every other day and still stay undetectable, allowing me build a stockpile of those meds in case of some future catastrophe. I did this by still getting subscriptions that provided 30-day supplies, then only needing half. I amassed years’ worth of med surplus!
But all that changed last year when I was hospitalized for a stomach complication and found myself understandably groggy and not fully with it after three surgeries in about three weeks. In that time, I had to come off all my meds for about a week—and when I went back on them, unbeknownst to me for about three days, the hospital care team put me back on Truvada without the Viramune. When I found out, I was horrified. I knew all too well that being on an incomplete HIV regimen could lead to resistance.
Some quick studying confirmed what I already knew, which is that tenofovir is in almost every HIV regimen
Soon I was back on the full regimen, but a few weeks later, in a realization of my worst fears, I learned that not only was I detectable, with my viral load around 600, but that I’d developed resistance to both Viramune (the common NNRTI mutation M184V) and tenofovir (the common NRTI mutation K65R). Some quick studying confirmed what I already knew, which is that tenofovir is in almost every HIV regimen, including almost every one-pill regimen. What was I going to do?
Thankfully, I had the assistance of not only my current provider, an excellent nurse practitioner at the NYC clinic APICHA, but of my former doctor, Antonio Urbina, MD (SEE What if I forget to take my HIV meds—or even lose them?). Independent of each other, they both recommended what I suspected from my own reading: the combination of the protease inhibitor Prezcobix (darunavir boosted by cobicistat) and the integrase inhibitor Tivicay (dolutegravir). That regimen, free of both NNRTIs and NRTIs, would give me a clean slate. And it was only two pills a night—no different from my old regimen, even if I had to take it nightly and could no longer stockpile a surplus.
It worked! In a few weeks, I was undetectable again, which was a great feeling. After more than 20 years undetectable, it had been highly unnerving to have extra HIV circulating in my body again, even at low levels. But the incident reminded me that undetectability is not a given—something beyond our control can happen that strips us of that status, even temporarily. Mostly, I was grateful that, in 2024, I had options to help me get back to undetectable. Twenty years ago or more, many people were not so lucky.