Changing from Kaletra to Reyataz

[Grendel]

Hi all-

I've lurked here for a long time, usually coming here when it was time to change my meds to do research. I was diagnosed in 1996 (11 years, who'da thunk it). Over the years I've had to change meds several times for various reasons. Usually because the previous combo was becoming ineffective. Once, though, with Crixivan, I had to change due to side effects (kidney stones).

Well, I'm changing again due to a side effect. The Kaletra has my cholesterol levels all out of whack, over 1,200. I'm a big huge walking stick of butter. Even after several diet changes to try to control it, my lipids just kept climbing. It makes me mad, because my current regimen, Kaletra/Trizivir, was so easily tolerated. I have been on it for years. But my doctor finally decided that since nothing we did could get my blood to be more like actual blood than sludge, it was time to change. It's for the best, I know, before I have a massive stroke or something, but still.

My main concern with my new regimen, which will be Reyataz/Trizivir, is the possibility of jaundice. I've done some research and it seems that hyperbilirubinemia is a fairly common side effect, but the yellowing of skin is fairly uncommon and the yellowing of eyes is even slightly less common. I'm also curious about dosing. My doctor prescribed Reyataz 200 mg, two pills a day. He said I could take the pills one in the morning, one at night, or both at the same time. He did seem to think I'd have an easier time taking them separately. (I think that's what he said. He might have said it would be easier to take them together once per day, lol. Now I can't remember.)

So my questions are-

1) Anyone else on this particular combo? Do you take the Reyataz all at one time? And if so, in the morning or at night?

2) Is jaundice common? Will it go away after a week or two? Am I incredibly shallow for being more concerned with how I look than the fact that I was 1 point away from a massive coronary due to runaway cholesterol? 

I did read somewhere that large doses of Vitamin C can help clear jaundice. Any truth to that?

PS-I just realized I accidentally posted this in the Living with HIV forum. I meant to post in the Treatments and Side Effects forum. Can a mod move this please? Sorry.

[newt]

Hello

1. Since you have taken PIs before the recommended way to use Reyataz  is 300mg + 100mg Norvir 1 x day. Note this is half the Norvir that's in Kaletra and it is to a large extent the Norvir that raises cholesterol with PI-based therapy.

2. Before you change, has your doc considered a statin?

3. About 30% of people on Reyataz get some elevation in cholesterol, less if they are also on Truvada/Viread (for some reason), but it is nearly always much, much less than other PIs, and often nothing at all at all at all

4. The AZT in Trizivir is prob. contributing to your raised cholesterol.

5. Yes, Reyataz makes you generally yellow for a few days on starting. It does pass, mine comes back (in my eyes) with too much drink/big steak, but on the plus side I tan easy.  It is not really jaundice in the hepatitis sense, just an excess of bilirubin floating around, so not dangerous/damaging, but can be cosmetically unfavorable.

- matt

[david25luvit]

Grendel....

                  Currently I am taking Reyataz/ Truvada / Novir and am having no problems at this time.  I've been on this combo for almost six months now and other than the initial side effects I've had no problems taking both pills at the same time.  I take my combo around six or seven at night....giving me plenty of time before I go to sleep around 2 AM.  Hope this helps....getting off Sustiva was the best thing I ever did.  A friend of mine takes Kaletra and suffers horrible stomach pains and dirreaha...maybe getting of it will be like me with Sustiva.  Good luck !!!!

[alberche]

Hiya Grendel,

I am on Truvada + Atazanavir + Ritonavir since 9 months ago.

I was before in Truvada + Sustiva, but had to change due to an allergic reaction to Sustiva.

I am OK with Atazanavir. Cholesterol is under normal parameters, LDL and HDL are in the upper normal, uric acid is also in the upper normals and bilirrubin is high, but I have not noticed jaundice or yewllowing at all, neither other people has told me I was becoming kinda tweety yellow form of life.

The major side effects I have had are some gas activity from time to time, diarrhea also from time to time (gets away eating more meat and worsens when I eat a lot of fruit), and fatigue.

3 months ago I have had psoriaris in my face, in the front, but it went away with a dermatological hydratant. I also have noticed pain in joints, in the hips. But my doctor says that these two manifestations are not due to treatment but to the virus itself.

I take my pills altogether, once a day, with dinner.

I try to drink 2 litres of water a day, eat a lot of vegetables and fruits and cereals, meat or fish or chicken 2 or 3 times a week, no frieds, no fast food, no sugar, no additives (if possible). I also go to the gym 3 or 4 times a week.

I am also taking a selenium supplement, as well as a vitamin and mineral supplement. I take them in alternative months.

Untill now, this has worked for me.

Regards,

;-)

[bocker3]

I am taking Reyataz/Norvir + Atripla.  My bili went up initially, to a high of 3.4, but after the first 3 months has been in the normal range.  I have never seen any "yellowing" in me -- even with the 3.4 bilirubin level.  When I added the Reyataz/Norvir to my regimen, I did see a tiny bump in my LDL to just over 100 (I've been on a statin for close to 12 years now).  My triglycerides did double (to a high of 184, last result was 158) -- but they were low to begin with, so all in all, I'm weathering the Reyataz just fine.
Of course -- everyone is different -- but I wanted to share my experience.

Mike

[GSOgymrat]

I switched off Kaletra because my triglycerides were 1600 and I'm now on Reyataz, Truvada, Norvir and Tricor. My total cholesterol is in normal range, my triglycerides are around 300. I've been on my current combo a year and a half and I still have periods of yellowing from elevated bilirubin. The yellowing is subtle and no one has commented on it but my partner and I notice it.

[jimw]

Hea Grendel,

I switched from Sustiva and Truvada because I could not handle the side effects from Sustiva, to Reyataz (300 mg), Norvir (100 mg) and Truvada.  I have had a lot of success and did not notice any yellowing of my skin or eyes.  I take my meds in the morning with or without a meal.  Good luck on the new regimen.   Jim

[jack]

did razmataz for a little over 6 months. Never got any of the yellow thing going. It did make me sick most days and I became resistant at 6 month mark and switched.

[Matty the Damned]

Matty the Damned takes Reyataz boosted with Norvir in combination with Trizivir. He looked forward to the famed jaundice side effect with moist anticipation, thinking it would be rather cool to look like a 6'4" gay banana but it was not to be.

He remains excruciatingly white.

I take all 300 mg of Reyetaz in one go and as far as I know I've had no problems with it. The Norvir and the AZT in the Trizivir have been problematic, but after some minor re-arrangement of the deck chairs on the Titanic that is my life it's proven to be the most tolerable combo I've taken to date.

Of course this could all change when I get my latest results next Monday.

MtD

[Grendel]

Thanks all.

I have been on it for five days now and so far, no yellow. I think. Hard to say. I stare so hard at my skin now I start seeing things.

The only real problem I'm having now is constipation, lol. I had gotten so used to fighting the horrible diarrhea I had with Kaletra that I kept up with my same solutions to firm up my, er, stool, that it's now way too firm. TMI methinks. Guess I'll have to figure out how to soften things up now, rather than make them harder. (Odd. Never thought that would be my goal in life!)

As for not switching the Trizivir for Norvir, I think that we decided not to do that since I tolerate it so well. And perhaps because I've never taken it, my doc figured it was better to keep some meds in reserve for when I would need them due to resistance. Or something. I'll ask about that at my next appointment.

Thanks again.