adherance

[blackbeauty40]

Hi, I have a quick question. I was put on Norvir, Truvada and Reyataz about 2 months ago (completely new to meds). I was (and still am) having a very hard time dealing with having to take them. I stopped taking them for about a week because my depression was really bad and I just didn't feel like it was worth it. I was wondering if I have messed myself up by not taking the meds for that week or can I go back to taking them as scheduled?

[Miss Philicia]

You may have messed things up, but then again you may not have.  There's no way to tell until you have tests run that show what your viral load is doing.  Depression related adherence issues are the number one cause for treatment failure if I recall correctly, so it's best to get a handle on this earlier rather than later.  What are you doing to treat your depression?  Until you get that resolved you're just going to continue, possibly, to have adherence issues.

[Inchlingblue]

As Miss P said, it's very hard to know whether or not your treatment interruption caused you to develop any resistance to your meds.

I'm not sure what the protocol is in a situation like this: either just go back on them and see what happens or get a resistance test first before going back on them? Something to discuss with your doctor, or you can try asking Dr. Gallant or one of the doctors on thebody.com

LINKS:

http://www.thebody.com/Forums/AIDS/Meds/index.html

http://www.hopkins-aids.edu/q_a/index.html?categoryId=9352&siteId=7151

I know you didn't ask for a lecture so please don't take it the wrong way but I feel I have to add more here, out of sincere concern for you as well as for anyone else in a similar situation who might be reading this.

We are living at a point in history in which HIV can be managed with drugs that are, for the most part, very tolerable. If you allow your depression to get the best of you, it becomes a very slippery slope to developing heavy resistance to your HIV meds and severely limiting your options, which then very much complicates your situation and worsens your prognosis.

Please try and get a handle on the underlying issues here, if you think you're depressed now, you'll be much more so in a few short years if you find yourself unnecessarily on salvage therapy and with few options.

Not to belittle your predicament but this reminds me of when kids don't want to eat and their parents tell them how lucky they are to have food since there are so many starving children in Africa. Can you imagine how many people who have HIV in Africa (and some even in the United States!) don't have the luxury of having access to Reyataz/Truvada/Norvir?

Check out this link (I mean it in the best possible way):

http://www.youtube.com/watch?v=0x-fkSYDtUY

[minismom]

This brings up a very interesting question: if someone stopped meds, how long should he/she wait until having a genotyping done to see if the virus had developed a resistence to it?  Would it show up right away, couple days later, weeks, months?

Mum

[Jeff G]

I stopped taking sustiva and truvada for about 10 months due to depression and drug abuse once . My doctor put me back on the same drugs when I was ready and I became undetectable within a month . I do not know if this is typical or I was just lucky .

I did pay a heck of a price for my drug holiday though . I had been successfully treated for Kaposi sarcoma up until the point of the drug holiday . It came back with a vengeance and I had to deal with that all over again . I will not interrupt my treatment plan again , it was a huge mistake that I regret .

[Ann]

This brings up a very interesting question: if someone stopped meds, how long should he/she wait until having a genotyping done to see if the virus had developed a resistence to it?  Would it show up right away, couple days later, weeks, months?

Mum

It would depend on how long it took them to become detectable again. I forget exactly how high the VL needs to be before they can run the tests, but something tells me it's around 1,000.

Ann

[minismom]

Ann, so as soon as the vl was detectable again, labs would show resistence?  That is very interesting.  Thanks!

[Ann]

Ann, so as soon as the vl was detectable again, labs would show resistence?  That is very interesting.  Thanks!

Well, yes, detectable, but not just barely detectable. Thing is, when there is resistance, it will be the resistant virus that will be replicating, so it should show on the tests. There has to be enough of it about though.

Ann

[Miss Philicia]

I'm not sure how wide scale this practice is, but I've heard of patients and doctors intentionally waiting for the viral load to get to 1000 (or maybe it's 1500 -- I forget the cut off number) so that they can get a clear geno/pheno lab report.

[Inchlingblue]

There could also be "archived" mutations that don't always show up, but for the most part resistance can be detected once there is enough of a viral load (>1000 copies/mL).

[Ann]

Missy, Inch, thanks, guys. I'm also pretty sure the VL needs to be at least 1000, as I mentioned the other day.

Ann

[aztecan]

Yep, Ann, you and the others are correct.

My doctor and I had this discussion. I was curious whether I could have a GART done. He said I couldn't because I was undetectable, adding I needed a viral load of at least 1,000 before they could perform the test.

I had asked because I have never had the test done. I have no intention of stopping meds just to have it done.

HUGS,

Mark

[Miss Philicia]

I had asked because I have never had the test done. I have no intention of stopping meds just to have it done.

Just to be clear, that was not the intention of my statement.  It's more along the line that if one sees say a 600 viral load one would let it go up to 1000 over the next couple of weeks to get the geno/phenotype tests done before switching medication.  Of course it would be silly to try and do this with a suppressed viral load.