Truvada/Etravirine - ID Doc Says It's Time

[WildcatCC]

She stopped in to my office today to tell me that my genotype was back. In other postings, I've mentioned that since testing positive in April of 2008 (though I suspect I was infected in 2004/05), I've been on 2 therapies; first Truvada/Presista/Norvir early on which brought my VL way down from 150,000 to 500 w/ a CD4 of low 300s and then Atripla which brought my CD4 up to the low 700s but my VL spiked to 1700. The CD4s are trending up but so was my VL so she ordered another genotype.

Today she told me that I have a slight mutation in my virus (she told me that before) and that I am not resistant to any class of drugs at this time. However, it seems this mutation is causing my VL to not get to undetectable levels with the meds. She wants me at undetectable as do I.

She suggested a new regimen of Truvada and Etravirene. She researched similar cases as mine and believes this combination should get me to where I need to be. I'm nervous about switching to another regimen so soon after switching to Atripla (July of this year). Part of me is balls to the wall let's do it - getting to undetectable is the goal. Part of me is concerned that I haven't given Atripla enough of a shot.

The game plan is to stay with Atripla for a few weeks as I have a reg scheduled blood draw early December and see where things are at.

In the meantime, does anyone here have experience with the Truvada/Etravirene combo? Or Etravirene in general? I looked it up in POZMeds but Jan 2008 is the last search result before the FDC approved the drug. No other recent info.

[Sebastian1969]

Hey WildCat.  Sorry to hear about the VL, I hope that the Atripla kicks ass for you in the next few weeks and you get to undetectable without having to do another switch.  I do not have any info for you on the other drugs, just sending good vibes your way that you get to the undetectable point.

[WildcatCC]

(posted on the Living With HIV Board as well)

She stopped in to my office today to tell me that my genotype was back. In other postings, I've mentioned that since testing positive in April of 2008 (though I suspect I was infected in 2004/05), I've been on 2 therapies; first Truvada/Presista/Norvir early on which brought my VL way down from 150,000 to 500 w/ a CD4 of low 300s and then Atripla which brought my CD4 up to the low 700s but my VL spiked to 1700. The CD4s are trending up but so was my VL so she ordered another genotype.

Today she told me that I have a slight mutation in my virus (she told me that before) and that I am not resistant to any class of drugs at this time. However, it seems this mutation is causing my VL to not get to undetectable levels with the meds. She wants me at undetectable as do I.

She suggested a new regimen of Truvada and Etravirene. She researched similar cases as mine and believes this combination should get me to where I need to be. I'm nervous about switching to another regimen so soon after switching to Atripla (July of this year). Part of me is balls to the wall let's do it - getting to undetectable is the goal. Part of me is concerned that I haven't given Atripla enough of a shot.

The game plan is to stay with Atripla for a few weeks as I have a reg scheduled blood draw early December and see where things are at.

In the meantime, does anyone here have experience with the Truvada/Etravirene combo? Or Etravirene in general? I looked it up in POZMeds but Jan 2008 is the last search result before the FDC approved the drug. No other recent info.

[Ann]

Hi Wildcat,

The Intelence (aka etravirine) AIDSmeds page was last updated on Sept. 14 2009.

I don't have any hands-on experience with this med, but there are forum members who are taking it.

Good luck with the new combo, hope you get to undetectable quickly.

Ann

[max123]

hi wildcat.

wishing you the best with the atripla and your goal...

do you know what your actual mutations are?

max

[Ann]

Hi again Wildcat,

I merged your two threads - I didn't realise last night that you had posted in two different forums. We prefer it if people do not post the same topic in more than one forum. It makes it easier for everyone to follow the conversation - and it's less confusing too.

Ann

[WildcatCC]

Thanks Ann. I'm a virgin (to these treads).   

I don't know what mutation it is - honestly I guess I'm too dumb enough to have asked the specifics of the mutation. I don't even know what questions to ask.

I also didn't realize the market name for the drug. Now that I know it's Intelence, I've read more about it. The side effects don't sit well with me - not the nausea but the skin issues. I'm already prone to skin issues so I will be sure to address with my ID doc in Dec when I do my new labs.

Thanks, all.

[Inchlingblue]

If your most recent genotype test shows no resistance to Sustiva (efavirenz) and Truvada then chances are you will reach undetectable so it makes sense to wait and see. The 1,700 spike could have been a blip.

You said she mentioned you have a mutation but that you are not resistant to any meds. This is normal, to have some mutations. Depending on which they are, some mutations cause resistance, some don't. You should ask for a copy of your lab reports, including the genotype test. These are very easy to read and understand, the genotype/phenotype test results show a list of all the meds and it clearly states for each one if you are resistant or not.

If you get to the point that you are seriously considering a change, Isentress (with Truvada) would be a combo to seriously consider. The likelihood of having Isentress resistance is almost impossible since it's a new class of drug (integrase inhibitor). And I assume you have no resistance to Truvada or she would not want to keep you on it.

Several people on here are on Isentress/Truvada, including myself. I am doing great and feel totally normal and healthy, no side effects to speak of.

[newt]

Today she told me that I have a slight mutation in my virus (she told me that before) and that I am not resistant to any class of drugs at this time. However, it seems this mutation is causing my VL to not get to undetectable levels with the meds.

(1) A mutation reducing the effectiveness of a drug is a resistance. Which mutation is it? I personally would be paying attention to anything affecting the Truvada, since this is the only constant between the two combinations.

(2) Also, it might not be resistance but drug absorption ie not getting enough drug. There is a test for this (for the efavirenz in Atripla and all PIs).

Prezista is pretty robust, and I am therefore suprised you didn't get undetectable with this, hence my point 1 above.

if you didn't get a rash from Atripla you are unlikely to do so from etravirine.

- matt

[max123]

hi wildcat.

lol...it's not being dumb, it's called being immobilized by hearing the word 'mutation' being uttered at you. trust me, i know from experience. luckily, my mutations were deemed insignificant. you should find out though, for your own benefit... as already mentioned, it's easy enough to get a copy of & is pretty important stuff.

max

[mecch]

I PM'd you but just adding that I have skin reactions to alot - drugs, food, stress - but on intelence so far so good.

[WildcatCC]

Met with my ID doc today. My genotype only shows a slight mutation to Epivir and Retrovir. My VL came down again but so did my CD4s. She doesn't want me to go too much longer without getting to undetectable so I'm giving Atripla another 30 days then we will assess again.

I suggested Truvada/Isentress which she seemed ok with but doesn't like the newness of Isentress. Basically she saying I should try a different regimen while I still can before I eventually reach the point that I'm immune to Atripla (no going back).

I feel great - no issues at all with the Atripla. I guess it's wait and see mode.

[max123]

hang in there