Combivir/nevirapine:other treatment options?

[Peacock]

Hello All, Im on COMBIVIR and NEVIRAPINE 2x per day, and my cd4 count has dropped from 628 ( in 19/12/2008 ) to 497 (26/03/2012)
My CD4 percentage has risen nicely to 30.10%
and my viral load is still undetectable.
Ive read a previous post where folks are talking about TRUVADA/INSENTRESS.
I initially wanted to stay on Combivir bacause its worked for me, but on second thoughts ive decided that I want to swap the Combivir for something less toxic (the AZT in particular) My big question is: should I swap to TRUVADA and stay on the NEVIRAPINE or should I do the TRUVADA/INSENTRESS combination?Im just concerned because the Nevirapine is a class seperate form Insentress...and maybe by staying on the Nevirapine I can save the Insentress for when my Truvada/Nevirapine starts to fail. Sort of like a backup.
Any suggestions? I will of course first discuss it all with my Doctor, Ive still got about 3 months meds in advance to use -so im not in any rush...just doing window shopping! the 2x a day type of regimen suits me fine.
Sorry-Ive modified my post a few times-after doing research and reading other posts...
So basically: Truvada/Insentress or Truvada/Nevirapine (as Im already on Nevirapine anyway)
Thanks folks!
Steve

[Billy B]

Hello S. Peacock,
I have been using Isentress/Truvada since I first started meds a little over two years ago. At that time Isentress was still fairly new and a lot was not known about long term use. Now there have been several adverse problems listed but I have not had any of them and my IDS still assures me that I am on one of the least toxic combos being used today. I still work 40-50 hours a week which is not bad for someone my age who has been + for so long.
I don't know anyone still on AZT because the newer drugs are easier on the body. Hopefully some of the other members will post because there are a lot of them here that have more valuable experience.

Peace,
Billy

BTW..."Are You Being Served?"

[Peacock]

Thanks Billy, Im definatly going to speak to my dr about a change. Ive not got any side effects but Azt's got such a bad name i think I need to start thinking about the future. Specially since I feel Im getting older and got more aches n pains. gotta preserve what Ive got.Green tea can only do so much for clearing out toxins hey!
Thanks for the post, I'll keep everyone updated on what my Dr suggests.
Cheers, Steve

[joemutt]

I switched from combivir/nevirapine to truvada/nevirapine a few years ago. no changes in cd4 no more side effects than on previous combination.

[Peacock]

Thanks, Joemutt, Hmmm..interesting. I might  join the Truvada nevirapine cocktail group!Its reassuring to know that someone out there is on the option Im thinking about starting. everybodys different and has different health issues and needs, and therefore on various cocktails that suit them..thats why its nice to hear from you, and to know how youre doing on the meds Im considering changing to. Thanks for the reply, i appreciate it.
I will let you know when I change over, if my Dr thinks its a good idea for me.
Cheers 4 now, Steve

[joemutt]

Join the club!  I had none of the seldom occuring immediate side effects of nevirapine ,though in the long run I think truvada needs to be monitored well (bone isues, etc) . my cd 4s do not vary more than on the combivir/nevirapine; the range goes from 950 to 1500 but at a 48- 50 % cd4 percentage. I have been diagnosed/on meds for 15 years soon so your mileage varies 
[Off topic, I have to add that I take the generic forms both of Viramune (nevirapine) which is called  Neravir here and manufactured by GPO-Thailand
and
also Truvada, brand Ricovir-EM, made in India by Matrix Labs. I was with the original brands for a while but the change to generics hasn't been an issue either.]
Here's to your continuing good health 

[surf18]

My first combo in 2010 was verimune/truvada
I was just dx'd and had cd225, so I was hyped up and he gave me potent combo.
Things went good for 13 days ,then I noticed a blotch on throat on Sunday afternoon. Next thing I know is I'm covered in a rash/ hives head to toe. Terrible. Days like this!!! He wanted me to work through this and I said are you f in nuts?! Get me off this shit. I still feel a year and a half later I'm just about rash free in my face.

[Peacock]

Geesh Surf18 thats unfortunate hey!Musta given you a hugh fright to get covered in rash and hives like that. Aargh.
and Joemutt... WTF!!! I wish I had your cd4 and percentage!Lucky dude! Im also on generic equivalents. Theyre exactly the same drug just with a different name.Sho, Im soooo jealous at your Cd4!Im going to assume your viral load is undetectable,hey?

[joemutt]

Right, VL undetectable and the last year lipid profile returned to almost normal.
Took meds since 15 years, I realize I'm lucky. I do some yoga and meditation and take 10 mg of simvastatin.
I have fat loss in my legs and arms but maybe that's previous medicine related (? azt, crixivan).
I also have fibromyalgia, tinnitus and hearing loss; maybe it's hiv or meds or aging.
The good thing about getting older is actually getting older. 

[alberche]

Dear Steve,

Another option is Epzicom (3TC+Abacavir) plus Intelence (Etravirine) or, as well, Truvada + Intelence. Intelence is a second gen NNRTI with much lesser side effects than Sustiva or Nevirapine.

To do the Epzicom you must first be tested to know whether you may be allergic to Abacavir.

I've been on both combos with no major complaints, but the usual: fatigue, some gastro problems, some dry skin issues.

Intelence is intended to be taken twice a day, but I am taking it once a day, the whole daily dose. I participated in a clinical trial during one year to validate this, and it seems to work as well as taken twice daily.

Hugs 

[eric48]

Sounds like a good number of patients are dropping Combivir (especially because of the AZT...) for more modern options.

On the other hand NVP has a very low drop out rate (except, of course for the first few month, where the drop rate is higher). Read though this forum and you will hear about people switching from this to that, but,  can hardly recall a thread where a patient, stable under NVP for a few years (like yourself), has mentioned switching away from NVP.

NVP is once daily (off label with the 200 mg version, legit with the XR version);
patent should become public domain shortly (thus pricing should go down)

I think you've spend well enough time browsing the net to understand that 628 (  or 497 is not different and that at that level, the only parameter to really look at is the %

One thing to consider (may be):
a recent cost evaluation made in Spain was ranking truvada+NVP as one of the most cost effective option.

[Costs and cost-efficacy analysis of the preferred treatments by GESIDA/National plan for AIDS for the initial antiretroviral therapy in adult human Immunodeficiency virus (HIV) infected patients in 2012.]
http://www.ncbi.nlm.nih.gov/pubmed

RESULTS: In the baseline case scenario, the cost of initiating treatment ranges from 6,895 euros for TDF/FTC+NVP to 12,067 euros for TDF/FTC+RAL. The efficacy ranges between 0.66 for ABC/3TC+LPV/r and 0.87 for TDF/FTC+RAL. Efficiency, in terms of cost/efficacy, varies between 9,387 and 13,823 euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC+RAL, respectively. In the most unfavourable scenario, the most efficient regime is TDF/FTC+NVP (9,742 per responder).   

The cost ratio between the 2 options your are considering is 1 to 2 ...
Of course, this may not be a real concern if your insurance provide full or good coverage, but, you never know what may happen on this front in the future.

Virologically, there seem to be (IMHO) very low risk switching the Combivir and keeping the NVP; a switch of NVP for RAL could be an other story, though

On top of that: TDF/FTC+NVP is once daily, TDF/FTC+RAL is twice daily.

At one point of my own treatment history, my doc was considering switching my Viramune+Kivexa for RAL+Kivexa (my VL decay was kind of slow). I was relived that I passed the final checkpoint and not have to switch my  NVP to RAL.
Honnest, I used to take twice daily (cecause of NVP) and can tell, as far as I am concerned, that the once daily is a real improvement

I have a personal preference for Epzicom vs Truvada, but understand it is highly debatable. There are pros and cons and that will depend pretty much on the patient's 'profile'

Hope this helps Eric