which drugs?

[macv]

Hi all, Hope everybody is well. I have been given 2 optopns
Sustiva and Truvada and when vl gets to u/d Atripla
or
Atazanavir and truvada.
First line therapy
dont know what to pic.
work funky shifts and have top deal with killer time changes although I work part time now.
what do you suggest?
many thanks for your help and love to you all xx

[Ann]

Mac, they're both good combos. They're both once-a-day dosing. The second combo probably also includes Norvir (ritonavir) as it's used to boost Reyataz.

If you work changing shifts, you may want to go with the Truvada/Reyataz because the Sustiva/Truvada is taken at bedtime to reduce the side-effects of Sustiva.

[phildinftlaudy]

I'm actually on Atripla - no real side effects have the first couple of weeks.
Some vivid dreams.
I'm actually moving the time I take mine up a bit as I am having extra morning grogginess -so doc told me to try that (actually, I suggested it and she agree it would be okay to do, as long as it doesn't make me "woozie" taking it earlier in the eve - which I know it won't because I take it now and stay up sometimes on the weekends)

I agree with Ann that the Truvada/Reyataz may be a better combo to start with...I think some of the little effects associated w/ Atripla are minimal/non-existant w/ that combo.

[macv]

Thanks again Ann xxx and phil.
 I think the Atazanavir has got ritonavir with it too. My o/h is on atripla so was wondering if it would be better if we are on the same medicine? Also the HIV nurse told me I could turn yellow taking Atazanavir, now I go on the sunbed anyway but that freaked me out quite a bit. Im allso s**t scared of wasting syndrome, I know its not as prevelent nowadays but still fraks me out. If I take the sustiva/truvada I know that sometimes I will have to take it in the middle of the day/middle of the night depending on where in the world I am or just before I report for my shift. Got an appoint ment soon on the 6th october with the doctor so I'll try and quiz him. Thank you once again much love xxxx

[Matty the Damned]

Thanks again Ann xxx and phil.
 I think the Atazanavir has got ritonavir with it too. My o/h is on atripla so was wondering if it would be better if we are on the same medicine? Also the HIV nurse told me I could turn yellow taking Atazanavir, now I go on the sunbed anyway but that freaked me out quite a bit. Im allso s**t scared of wasting syndrome, I know its not as prevelent nowadays but still fraks me out. If I take the sustiva/truvada I know that sometimes I will have to take it in the middle of the day/middle of the night depending on where in the world I am or just before I report for my shift. Got an appoint ment soon on the 6th october with the doctor so I'll try and quiz him. Thank you once again much love xxxx

The yellowing (aka jaundice) associated with Atazanavir is no big deal. It's usually very mild, hardly noticeable and it settles down in a couple of weeks. It's not harmful.

MtD

[newt]

They both work and are both once a day.

The main side effects of efavirenz relate to the central nervous system. These can include mood changes such as anxiety, euphoria and depression, and sleep disturbance that includes vivid dreams. Most people get them to start, but they usually pass. About 10-20% of people stop efavirenz because of the general effect on their quality of life. Most people find it is best taken on an empty stomach. (though Truvada can make you fart without food...)

The main side effect of atazanavir is production of excess bilirubin. This can make your eyes look a bit yellow. This is common at the start, but not really noticable in most people. This also usually passes. Also, for some people the Norvir booster raises their lipid (blood fat, cholesterol) levels, for maybe 15% of people or so. Must be taken with some food, but can be little eg a sandwich, glass of milk.

Timing wise, once you get undetectable (viral load of below 50 copies) this shouldn't matter on either med (in terms of them working) as long as you take it daily. Atazanavir is probably better in this respect (for various technical reasons).

Also, did they not offer you darunavir? This is a PI like atazanavir, also once a day, but doesn't have the yellowing effect. You might ask and see if it's on the cards.

Choice of drugs should be informed by a resistance test. I trust the clinic has done this...

You might like this UK resource:

i-Base guide to combination therapy
http://i-base.info/guides/starting

I wouldn't worry about the wasting. None of the meds your doc is suggesting are connected with fat loss or fat gain in a big way. This was mainly from old drugs that aren't used so much now (AZT, d4T especially).

Good luck.

- matt

Edited for spelling

[macv]

Cheers matt, I think Im gonna go for the atazanavir and thanks for the link to I base, I read it every week. Lots of help out there for HIV positive folk. Both here and I base. What a wonderful amount of knowledge I have gleaned from both web sites. Thank you all, your knowledge and compassion are priceless. THANK YOU XXXX

[Ann]

You're more than welcome, Mac. The Reyataz/Truvada combo is currently my first choice for when I need to start. Good luck!

[mecch]

If you go for the Reyataz, you might want to quit the suntan booth during the first months. I turned yellowish on Reyataz and got away with it cause it was winter and people thought it was a ski tan.

Tan + yellow (if you get it) might be a bit overkill on the coloring!

Personally of my several combos, the sustiva was the worst overall experience - I am in the minority of people who got emotional effects.  But, er, frankly, my poop was never great on the norvir+protease, and I tried two different proteases.  And on Sustiva, then Intelence then Isentress, the digestion is perfect.  Hmmm

Six of one, half dozen of another.  Whatever works for you, you'll find it either sooner, or later.

[macv]

I was all set to start medicine, went to clinic today and they said my cd4 has gone back up from 350 to 550 and my VL has gone down from 6k to 3k.How can this be? my cd4 has been steadily going down for the last 6 months. I was all set in my mind i'd have to start but this is good news I think....

[littleprince]

Also the HIV nurse told me I could turn yellow taking Atazanavir, now I go on the sunbed anyway

I'd be more worried about the sunbed and getting skin cancer.

LONDON — International cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas.

A new analysis of about 20 studies concludes the risk of skin cancer jumps by 75 percent when people start using tanning beds before age 30.

http://www.msnbc.msn.com/id/32187497/

[newt]

went to clinic today and they said my cd4 has gone back up from 350 to 550 and my VL has gone down from 6k to 3k.How can this be?

Maybe your body has decided to kick HIV into the corner for a while.

Numbers bounce around. I would want 2-3 tests showing a downward trend before starting combo.

This may be a one off rise tho, don't be disappointed if next time your CD4 count is back round 350. CD4 cells are kinda mobile, going here and there, from blood to spleen to lymph etc. +/- 50-100 on CD4 counts is quite usual.

6k to 3k viral load is basically the same ballpark and can be discounted as a significant change at this point.

- matt