Back to my Old Combo,,,, for now at least....

[egello]

After about 10 days of being dazed, depressed, confused, anxious, and being constantly tired and having neuropathy like feeling to my legs, I decided to quit Atripla, or rather, I just didn't want to take another dose of it any longer... I cringed at the thought of taking another one tonight and taking me on that Sustiva journey.

So I got my doctor to call my pharmacy and prescribe my old regime back which was Truvada with boosted Reyataz.

I really had no side effect with my old regime except the idea that I was taking Norvir which aways made me wary of that combo, however, I now appreciate them soooo much more.

I still want to try Viramune and Truvada combo because I heard that Non Nuke especially Viramune is lipoatrophy friendly,,, but not exactly sure if there has been any scientific research done on this topic.

Does anyone know?

[allopathicholistic]

I really had no side effect with my old regime except the idea that I was taking Norvir which aways made me wary of that combo, however, I now appreciate them soooo much more.

Hi

That was my first regimen back in late '05 and early '06 and the doctor said I can never go back to it. He said why but I forgot. I'm not trying to insinuate anything - I'm just sharing.

[egello]

maybe you became resistant to reyataz?

[allopathicholistic]

maybe you became resistant to reyataz?

no. i've never become resistant. ever. i was take off the combo bec my eosinophil level was rising to unsafe levels (anything over 8 is cause for concern and mine were at 15. they are now down to 5 which is normal) but as far as I can remember - and this will sound crazy - that wasn't the reason given as to why i can't ever go back on reyataz-truvada-norvir

[shadowfluid]

After about 10 days of being dazed, depressed, confused, anxious, and being constantly tired and having neuropathy like feeling to my legs, I decided to quit Atripla, or rather, I just didn't want to take another dose of it any longer... I cringed at the thought of taking another one tonight and taking me on that Sustiva journey.

So I got my doctor to call my pharmacy and prescribe my old regime back which was Truvada with boosted Reyataz.

I really had no side effect with my old regime except the idea that I was taking Norvir which aways made me wary of that combo, however, I now appreciate them soooo much more.

I still want to try Viramune and Truvada combo because I heard that Non Nuke especially Viramune is lipoatrophy friendly,,, but not exactly sure if there has been any scientific research done on this topic.

Does anyone know?

You are tolerating the combo well right....so what's wrong with Norvir?

[egello]

i mention in my other post that i was like slight lipoatrophy as noticed by my hairdresser especially.... and i am sort of attributing my lipoa. to Norvir since I didn't loose weight at all

[Sydney]

Hi Egello,
I did a fair bit of reading on Viramune - because I didn't want to go on efavirenz.  I found some useful information in the forums - if you do a "search" of the forums with "Viramune" you'll get some useful stuff.  A couple of random suggestions, plucked out of my file:

* Go to the topic "Treatment Naive and Viramune" - posted by Darwin on May 09, 2008.  Peter Staley gives a helpful reference to a chart comparing the pros and cons of Efavirenz and Nevirapine.
http://forums.poz.com/index.php?action=dlattach;topic=20779.0;attach=17351

* A good summary of the research on switching between efavirenz and nevirapine is
http://www.hivandhepatitis.com/recent/2006/ad1/120806_d.html
"Switching from Efaviranze to Nevirapine Resolves Neuropsychiatric Symptoms and Improves Lipid Profiles"  If I haven't got the link right, go to "Sustiva probs? Check this out.  Post by ajm_idn on May 11, 2007

* Another conversation thread: "Switching - Stocrin to Viramune", Post by parteboy on May25, 2008 (some good info there).

*Also: "Viramune and my doc" - post by Asurbanipal on May 29, 2008

* Also "Switch Viramune to Scotrin?" post by J.R.E. on April 10, 2008

* Also "Raash with Viramune"  - post by Pippet on December 06, 2006 (some useful info on possible side-effects)

One of the biggest research papers is "An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults (J.A. Bartlett et al, 2006.  AIDS 2006, 20:2051-2064.  I think I might have given a summary of the findings in my post some time fairly recently - not too far down the list.

Happy hunting and good luck.
Sydney

[jennynyc7]

I have been on Truvada + Viramune for only 6 months or so and can only speak of the side effects (or lack thereof), not lipo since it hasn't been long enough. I don't have a single side effect. For the first couple of weeks the Viramune made me drowsy/high but I always take it at night so it wasn't a big deal, but that has subsided. I really like the combo and hope that it works for a long time to come!

j

[franfrog]

I know when I started in the hospital four years ago they started me with tuvada( I am almost poz) and I believe he told me they could not start me back on it.  They had to stop it after a day or two because I was having a reaction to one of the meds and they did not know which one.  He could not start me back on the truvada so he changed it to combivir and sustiva. 
I could almost swear that is the one and it all turned out to be that I was allergic to the sulfa in the meds for the PCP.

[egello]

Thanks Sydney

I have been doing a lot of research and reading as much as I could regarding Viramune, Reyataz and Sustiva. However, I wasn't able to find any information comparing Viramune vs. boosted Reyataz, comparing which might be bit more lipo friendly...

[Sydney]

Thanks Sydney

I have been doing a lot of research and reading as much as I could regarding Viramune, Reyataz and Sustiva. However, I wasn't able to find any information comparing Viramune vs. boosted Reyataz, comparing which might be bit more lipo friendly...

Hi mate,

My guess is that it may be hard to pin down an exact comparison - especially since there are so many "moderater variables" in play.

I don't know whether you read the aidsmed article on lipodystrophy
http://www.aidsmeds.com/articles/Lipodystrophy_10734.shtml
But just a quote about Reyataz: "One protease inhibitor, Reyataz (atazanavir), is believed to be the least likely to cause increased lipid levels in the blood (the risk of raised lipid levels may increase slightly when Reyataz is combined with low-dose Norvir.  it is not yet clear if Reyataz is associated with fat accumulation, although some clinical trial data suggest that it is not."

And in terms of the NNRTIs, Nevirapine is considered to have "less lipid effects that efavirenz" (see the comparison chart I mentioned).  Further -one clinical study showed that after a switch from efavirenz to viramune
- total cholesterol decreased by 17.8 mg/dL;
- low density lipoprotein (LDL or "bad") cholesterol decreased by 25.5 mg/dL
- triglycerides decreased by 70.1 mg/dL,
- high-density lipoprotein (HDL or "good") cholesterol increased by 5.3 mg/dL

I know it's an inference, but I've gained the impression that (ceteris paribus) Viramune has an edge over boosted Reyataz - though I stand to be corrected by firmer evidence.  Have you tried a Google search?
cheers for now.

[egello]

Thanks Sydney

Yeah, that was the impression I got from doing some reading, but thanks for the hard clinical data. Yeah, I also heard that Reyataz was very lipo friendly, just that most of us take it boosted,,, so wasn't really sure....


Thanks and have a good day

[Miss Philicia]

"lipo friendly" doesn't mean you receive any guarantee, but I guess you know that right?

[egello]

yes, ms piggy...

I went back to my doctor today and he prescribed me Carnitor and Viramune.

He told me to combine one Viramune with my Boosted Reyataz for one week before taking two at a time.

He also suggested that some scientist actually think that it could be the Norvir that prevents people from getting Lipoatrophy.

I will see how this Viramune goes,,, hope all goes well with this new drug.

[allopathicholistic]

hi egello. update. my doctor said the reason i was taken off of reyataz trvada norvir was because of something in my body called bilirubin. again, i have never had resistance (knock on wood) and will do everything humanly possible to keep that true

[newt]

Egello

Since Norvir induces lipoatrophy in mice I think your doc is talking out his/her proverbial

Non-nuke combos (including non-NNRTI combos) are associated with less chance of lipoatrophy.

- matt