More Truvada/Isentress as first line questions

[carpediem98]

I feel like I'm harping on this particular topic, but after reading what you all have to say and reading the research that's out there, I'm more convinced than ever that when I start HIV medicine in the near future, it should be a combination of Truvada/Isentress (or perhaps the Gilead 4-in-1 and just suck it up and take the chance of being in the Atripla arm and getting some of the unwanted efavirenz side effects).

Yesterday, in discussing it with one of my doctors who treats a certain aspect of my strange case, I was surprised by her EXTREMELY negative reaction to the idea of taking Isentress+Truvada as first line.  After probing, I discovered that the primary reason is that it's twice a day and that adherence issues would worry her (although I'm usually very adherent to necessary medications - but "usually" isn't "always," I have to point out to myself... it would require some adjustments - but not as many adjustments as efavirenz, since I'm a late eater, an irregular sleeper, etc.).

I know there are studies going on right now for Isentress to be once daily.  Is anyone here taking part in that, and if so, how is it going?  I'm assuming they're testing you to make sure enough of it is staying in your bloodstream to avoid resistance emergence... Would anybody be willing to discuss their experience of Isentress 800 mg daily with the usual once-a-day Truvada?  Or does anyone else have thoughts regarding it or knowledge of when study data are expected to be in?

Needily Yours,
Carpe

[mecch]

Truvada Intelence is also twice daily and I dont have a problem remembering to take the pills.

[Inchlingblue]

I haven't yet started meds and when I do I plan on Isentress/Truvada. I've researched it TO DEATH. Asked several doctors, read everything I can get my hands on, etc.

Also chatted with tag_man08   who is part of the once-daily Isentress study, in case he doesn't see your thread you can always send him a message.

I'm confident it will be once a day in the not-too-distant future and in the meantime taking it twice a day is a small price to pay when weighed against the very many apparent benefits.

[carpediem98]

I'm in total agreement with you, Inchling.  I was sort of surprised that an informed doctor, part of a major research network, would have that kind of reaction to something that's produced such good data and such great patient testimonials.  It's sort of unprecedented in HIV care, from everything I can tell (but I have to admit that compared to a lot of people on these forums, I am a BABY when it comes to HIV - having been infected for just over a year and knowing for less than a year).

I sent a message to tag the other day... haven't heard back yet.  The gall, not structuring his days around replying to messages from me! 

I have certain misgivings about Intelence, insofar as it has a sizeable number of drug interactions... but glad to hear that you aren't having any adherence issues with it! 

[Inchlingblue]

I'm in total agreement with you, Inchling.  I was sort of surprised that an informed doctor, part of a major research network, would have that kind of reaction to something that's produced such good data and such great patient testimonials. 

It's good that her misgivings have to do with her not being sure if 2x a day might lead to missing a dose as opposed to something having more to do with the effectiveness of the drug itself. Does that make sense? lol

I'm also a newbie about all this, I found out I was poz August 2008 but part of how I cope with it is to learn as much as possible about all things HIV. In these few short months I think I'm becoming somewhat of a lay "expert," I spend literally 3 to 5 hours (or more) every day reading about all aspects of HIV/AIDS.  After I first found out it was even more.

I know it seems like a bit much and I guess I can now taper off a bit more but having hard facts and more accurate knowledge about all the specifics is what's actually helped to keep me sane.

At the end of the day we're very lucky that this is what we're considering: whether to take Isentress/Truvada or Atripla or maybe even Rayataz/Isentress/Truvada, etc. These are all very good options to have. I think the Gilead 4-in-1 will also be a great option but I wouldn't do a clinical trial unless I had to.

Another of the big selling points for Isentess/Truvada for me is that I don't have to worry at all about whether to eat something or not and  if I do, whether it should be low fat or not, etc etc. I would much rather do 2x a day dosing than have to time my dinner to a certain time frame depending on when I was going to take my meds (as one has to do with Atripla).

So she is reluctant to prescribe it because she is concerned about adherence with 2x a day? Her concern probably comes from the fact that maybe most of her patients would have a problem with twice a day, based on her experience. Only you can really know for sure if this is an issue, I know for me it's not.

I totally forgot I had already mentioned Tag_man08 before lol....I'm sure you'll hear back...he's basically very happy with Isentress/Truvada, although I didn't ask him specific questions about the dosing study he's on, like whether he knows what dose he's taking etc

[mecch]

Another of the big selling points for Isentess/Truvada for me is that I don't have to worry at all about whether to eat something or not and  if I do, whether it should be low fat or not, etc etc. I would much rather do 2x a day dosing than have to time my dinner to a certain time frame depending on when I was going to take my meds (as one has to do with Atripla).

People who take atripla do not have to eat meals at a certain time, NOR do they have to take the pill at an exact time everyday. 

[Miss Philicia]

People who take atripla do not have to eat meals at a certain time, NOR do they have to take the pill at an exact time everyday.  

Actually one is supposed to take it on an empty stomach, not with a meal, as fatty foods increase the levels of efavirenz and therefore the side effects.  So yes, there is a restriction even if it's the reverse of taking it on a full stomach.  Isentress and Truvada have absolutely no restriction either way, so indeed the dosing is more flexible.

But since once also is supposed to take Atripla before bedtime this is pretty much a non-issue, as most people do not eat a full meal at 11 pm and then hit the mattress.

[Inchlingblue]

I know someone on Atripla who has to make a point of eating his dinner a certain number of hours before he goes to bed otherwise he said he gets the weird dreams and dizziness. He also said something about the level of fat in what he eats and how that also has an impact on the side effects if he were to take the pill too soon after eating dinner (as Miss P said, I guess high fat would increase the effects).

Maybe not everyone has this happen to them as far as food interactions with Atripla? I guess you don't, mecch?

If I had to take Atripla I would, I know all it's benefits, but if I'm able to opt for something else (which appears to be just as good and maybe even better in some ways) in order to avoid all these food-related cocerns then it makes sense to me to do that.

As far as taking pills at the same time every day, ideally all HIV meds should be taken at the same time, but I'm aware that there is also some "wiggle" room with most of them, within reason.

As I said above to carpediem, we're fortunate we're able to choose from these options since so many in the past didn't have that luxury (and come to think of it many people even now don't have that luxury, actually!).

[Miss Philicia]

Yes, I agree Inchling.  It's not that Atripla is a bad med, it's just that it seems it has a higher chance of being so. I'm quite sure that in just a couple of years it will go to being a "second line" choice.  I've always thought it was overrated a bit, mostly because it's available in one pill.

Isentress/Truvada combo aside (only for those that don't like the not-approved-as-first-line aspect), I'd still select a Reyataz/Truvada before Atripla if I was commencing treatment in 2009.

[mecch]

As far as taking pills at the same time every day, ideally all HIV meds should be taken at the same time, but I'm aware that there is also some "wiggle" room with most of them, within reason.

If I were you, I'd go for the isentress or the reyataz.  Personally I couldn't take the side effects of sustiva. I'm on a much newer NNRTI.

I was commenting because this is a public forum and your pronouncements on timing are INCORRECT. Once Atripla is going a few days, you can take it pretty damn flexibly. At 22h or at 4 am when you come home from a party. It doesnt freaking matter.

There are people who have dated instructions saying take exactly the same time, use an alarm clock, etc etc etc.  There are people jumping through hoops for strict dinner times and taking their Atripla times and its all for nought.  Strict dosing time may help them remember but I quizzed TWO HIV experts at the best swiss hospital and they assured me - timing is not the issue with ATRIPLA.  Adherence is.

Everyone should ask their ID about the specific timing obligations of their HAART.  

You seem to be quite concerned about strict timing and how many times a day and honestly this won't be the main issue once you go on HAART.  It will be how effective it is in YOUR body on your hiv, and what kind of side effects or not it has.

[carpediem98]

Started Isentress+Truvada today and it was, without a doubt, the completely correct choice.  Not only do I feel a sense of relief at being on offense rather than playing defense... I even felt a little psychosomatic change and felt somehow more "normal" physically.

I have had no real side effects to speak of: normal bowel movements, the mildest of headaches for about 15 minutes (which could just as likely have been due to not sleeping last night in anticipation of today's appointment).  The primary thing has been a mild nausea and an unusually strong appetite, especially for fatty foods that I normally avoid - ice cream, french fries, doughnuts, cheese, etc.  I suspect that's the "comfort/reward" part of the brain at work, telling me I deserve a treat for being such a good boy and starting the medicine.  The nausea is real but not bad.

It is SO the right choice to start "early," I believe, and for me this was DEFINITELY the right combination.  Thanks to those who offered advice, personal experiences, etc.  I'm very happy with this decision.

[Inchlingblue]

wow, congratulations........I'll probably be starting soon so I'd really appreciate if you could give is a little update at some reasonable point in the near future as far as any side effects etc........I have one question: what  time are you taking it? Is it two Isentress and one Truvada pill per day?  Thanks!