Which PI?

[richva]

Hi, All -

I've read plenty, but what I can't seem to find is a real-world, side-by-side comparison: Reyataz vs. Lexiva vs. Prezista - each with a Norvir boost - and with Truvada to accompany the PI pairing.  Help!

Started with nighttime dose of Atripla - 3-4 very good months, virologically awesome, no unpleasant side effects - then the relationship went south.  Can't sleep, no matter what I try.  Insomnia lasts for a few weeks, then improves (due to sheer exhaustion, I imagine), then worsens.  Ambien, Lunesta, Trazadone, Ativan....  No relief.

In the past few days I've switched to A.M. dosing; sleeping better, but having to negotiate the Sustiva funkiness throughout the morning isn't ideal.  Fine today since it's Saturday, but Thursday and Friday mornings at the office required a tremendous amount of concentration just to operate a stapler.  (Okay, that's a little extreme... but actually not too far from the truth.)

My ID doc is terrific... says I'm a real "trooper" for having hung in this long - but apparently hell bent on having me choose which PI to go with if (when, really; it's just a matter of time) I do decide to tell Atripla to take a hike.

Any thoughts?

Again, I've read the lessons on the drugs, understand something about each, no known allergy to sulfa drugs, no bothersome stomach acid issues, yadda yadda yadda....

Should I just flip a coin?  Rock paper scissors the whole thing???

In advance, thanks for pointing me to the comparison I seek or to shedding some light on the topic.

Rich

[newt]

Personally, I would start with Reyataz or Prezista, cos they's genuinely once a day and use least Norvir, and if it doesn't agree then go for sommat else. Do not forget Kaletra (Aluvia)...older, but effective. Reyataz has a longer half-life, so more forgiving. The side effects is kinda personal, but truthfully there's prob not much to choose between the three you list.

- matt

[richva]

Thanks, Matt, for your response.  Very much appreciated.

In a reply to Peter recently, you referred to Prezista as a resistance buster... which makes me think that, although not a particular worry for me today, I might be wise to go with Reyataz and keep newer options available for a later time...?  Something to think about, I suppose.

Best -

Rich

[aztecan]

I'm with Matt.

I would go with the Reyataz since you have no stomach acid issues. It is very easy to take, just once a day, and I had no side effects from the med itself.

I now take Lexiva because I, unfortunately, do have stomach acid issues.

Good luck with the switch.

HUGS,

Mark

[richva]

Hello, Mark, and some hugs right back atcha   I appreciate your input. 

Well, finding no glaringly-obvious benefit of one PI vs. another (and seeing no particular reason not to follow what seems to be a tried-and-true route), I'm (99%) sure that I'll ask Reyataz, Norvir & Truvada out on a date... just as soon as I make (what shouldn't be, but what has certainly become) the difficult decision to end things with Sustiva.

I'll try to be nice about it, though, so as not to burn any bridges


Rich

[mecch]

Hi there Rich,
Wondering why you are waiting and putting up with the sustiva baloney, if its not working for you. Geez, since we got have HIV and gotta work, at least we can have low impact HAART.  I had to really badger my ID to switch out the sustiva (not sure why, since I have no resistances), to reyataz.  Within days I was calmer and my side effects disappeared, work was a breeze again, so we can assume it was the sustiva.  Good luck.

[richva]

Thanks, Mecch, for your thoughts.  Yours is a story of recently switching meds that I have read - and re-read - and thought about quite a bit.

In response to your post, I'll have you know that I have plenty of reasons for "putting up with the Sustiva baloney" for as long as I have....

The problem, I admit, is that not one of them is a particularly good reason.

Others might have made the switch a long time ago.  Others, after just a few sleepless nights, might have said, "No way, no more, no how."  We're all different.

As for me, I think I needed a discussion with my ID doc on Friday, some feedback from a few trustworthy resources here at AM over the weekend, and a couple of extra days to come to terms with (i.e., grieve) the oh-so-evident fact that Sustiva and I aren't a match made in heaven.

Again, thanks to you (and all) for your well-intentioned kicks to my rear end.

Rich

[mecch]

Well I'm such a newbie Rich, so yep I don't have much to recommend or any great experience. I hope if and when you switch you get some sound sleep, which feels so great.  Now tomorrow I will ask my ID why he resisted switching me during 6 weeks of crazies. I guess a lot of people see the long run of all this.  Good luck to you.

[richva]

Thanks again, folks, for helping me to quit my whining and reconnect with a little courage and determination.  After a morning chat with my doc, new scrips are being faxed in and should be ready for pick-up after work.  Now that the decision has been made, I'm relieved, actually - and really looking forward to putting some distance between efavirenz and my pillow.

Best,

Rich

Edited to add: I chose Reyataz w/ Norvir to replace the Sustiva, opting to save any "resistance buster" PIs for a later time, if needed.  Truvada completes the combo.

[mecch]

Ok cool. Thats my combo and switched off the sustiva. I saw my ID this morning. He apologised - said it was his error to make me suffer 6 weeks with sustiva crazies since when I started reporting the troubles he kept replying it was anxiety not the medicine.  I ended up on sleeping pills, a fair amount of anxiety medicine (temesta, lexotanil). 

Well listen, a few days onto the Reyataz, I felt much better.  In the end, I can imagine most drugs have some side effects especially if you concentrate on looking and feeling for them. 

Hope you have great success with the reyataz - or at least good night sleeps.

[richva]

Just an update:

It's been a week since I switched from Atripla to Truvada/Reyataz/Norvir.  I take it in the morning with cereal and coffee while checking CNN online (and FB and AM as well).  No undesired side effects to speak of.  I'm optimistic - cautiously so, as is my nature. 

Conversely, my sleep patterns are returning to normal, and I actually have the energy (and enthusiasm) to do things.  Anything.  Clean out over-stuffed closets.  Organize things in the basement.  Run unused items over to a local service organization.  Go to work.  Walk the dog....  I knew that Atripla - or, I should say, I suspected that Sustiva - was impacting my life.  I just don't think I understood to what extent.

I wasn't feeling unwell when I started meds in April 2008; the numbers just said, "It's time."  Then, for nearly 7 months I felt somewhat "off" much of the time.  For me, insomnia was the main issue, so I didn't pay too much attention to the nearly-daily bouts with dizziness, or the forgetfulness, or the jumpiness, or the worrying.  I told myself that the meds are working... and simply convinced myself that I should just accept this as how my life on meds may have to be.

With or without this AM Forum, I knew I had to do something.  However, I found the information, motivation and encouragement to risk something unknown (to me) right here.

So, as we roll into a new year, I'd like to again say 'thanks' to all of the folks here who light paths so that others may find their way.

Best,

Rich

[mecch]

Rich, glad to hear the good news.  I had the same feeling about the return of energy. I had a great return of energy when i went on sustiva (from uncontrolled viremia down quickly with HAART), and then after two months my energy nosedived. Now I reyataz I have renewed energy. Skiing like a maniac, here, for the holidays.

Hope your energy boost lasts and that you sleep LONG and peacefully.