from Kaletra to Sustiva, what to expect?

[elf]

Hi people,
I asked my doctor to change my regimen (Kaletra+Epzicom) because of high
triglycerides (157.66 mg/dL), high LDL Cholesterol (177.88 mg/dL) and high total cholesterol total (274 mg/dL). I've been taking Lovaza (which slightly helped with my triglycerides, but not much). I quit taking niacin (took it for 6 months) because it did nothing (but it messed up with my liver, AST, ALT are all 5x times higher than normal).

Now I'm taking Sustiva+Epzicom (2 pills only, before going to sleep)...I'm on the 4th day with this regimen? What can I expect?

Will cholesterol go down (at least a bit)?

I've heard that my CD4 numbers may go down now, because Sustiva is less potent.
[I've had CD4>1000 for two years now. My latest results 1130 (33%). VL 21]

Is this true?

No Sustiva side effects thus far.
(I'm taking 20 mg of melatonin before going to sleep).

I hope my CD4 don't sink below 500 on Sustiva. 


thanks for help
and happy holidays

[OneTampa]

I've taken low dose Sustiva (400 mg at bedtime) for over 10 years. My numbers have done well and I have remained undetectable for years.  You may or may not experience vivid dreams (along with high definition colors, surround sound and stories with interesting plot twists) like I do.  I've never had nightmares although some people say that they have.  It appears that each person's experience with Sustiva's side effects may be different.

Good luck!

And, Happy Holidays to you too!

[buginme2]

I've heard that my CD4 numbers may go down now, because Sustiva is less potent.
[I've had CD4>1000 for two years now. My latest results 1130 (33%). VL 21]

Is this true?

Less potent?  Where did you hear that? 

I'm sure your cd4 count will be fine.  However, Effavirenz also increases cholesterol.  It has mine.  But maybe not as much as what your currently on.

[newt]

Efavirenz (Sustiva) can increase triglycerides, but is generally better than Kaletra for other types of cholesterol. On CD4 count, I doubt you will see a significant effect given your count is so high, so please don't fret about this. Studies on people who started treatment with low CD4 counts showed a median +50 increase on PIs like Kaletra compared to NNRTIs like efavirenz, but this was like starting at a count of, eg, 200 or less. I don't know what you mean by less potent here, efavirenz is perhaps more effective according to studies at reducing viral load, and, even with the dreams etc, has less side effects.

- matt

Now playing: so enjoying my Chrome browser with as-you-type spelling checker

[eric48]

hi,

if you are having LDL at 177 and total chol. at 274 , I am I correct in saying thinking that your HDL is 97 ?

and why do you think TG=157 is high ? on my lab sheet the upper limit of 'normal' range is 200...I am at 70 which is considered low ... I do not get it ...

If I am correct your HDL/LDL is 0.54

I may have got your numbers wrong, but actually they are not much different then mines

LDL 160
HDL 80
HDL/LDL =0.5
total :256

Total (256) is above range (200) but my little personal research lead me to understand that having HDL > 60 the the Holy grail of the cholesterol obsessed people like myself because it is now know to be the wild card that wins over all other 'bad' number.

I have run my numbers through a number of risk calculators and the outcome was that my estimated risk is lower than the lowest.

Your numbers are to die for !

Some people have a hard time understanding that people with high HDL numbers can not have 'normal' total cholesterol because there is no way you can fit a HDL of 97 and what ever LDL in a total of less than 200. It is just how the maths go.

LDL at 177 and HDL at 97 ?

Unless you have some other risk factor (smoking/diabetes or over 50) I do not understand where your concerns are...

Do you smoke ?

Cheers Eric

[elf]

Yeah, but HDL is that important in heart attack risk assessment
http://hp2010.nhlbihin.net/atpiii/calculator.asp

Risk Score*    1%
Means 1 of 100 people with this level of risk will have a heart attack in the next 10 years. 

[newt]

Elf, if that 1% is the risk you get from the calculator using your numbers you haven't really got an issue to worry about, it's about as low as the calculator goes (does give less than 1% sometimes).

- matt

[eric48]

Hi,

I have played quite a bit with my numbers which are quite similar to yours on various calculators and always found low numbers.

They are usually based on the so called framingham cohort results (see wikipedia for details); it is not the only cohort but the oldest and mostly used.
http://en.wikipedia.org/wiki/Framingham_Risk_Score
http://www.framinghamheartstudy.org/

Since you are taking Abacavir, I can draw your attention to one that also adjust to correct for the suspected (but highly debated) abacavir additional risk.

http://www.chip.dk/tools.aspx

This tools is at the same time usefull and flawed:
A- because it uses the DADS abacavir suspected additional risk, a risk that is NOT confirmed by some other studies, see for example the latest VA study that do not confirm this suspected risk
B- because is multiplies the risk by 1.9 , an across- the-board multiplicator whereas the DADS report is absolutely clear in that the additional risk is NOT the same depending if you are on the low risk strata or the higher end (the multiplicator is about 1.1 if you are in the low risk group!)

I have discussed that in several post, I can't remember where, but it should be somewhere in this thread:

http://forums.pox.com/index.php?topic=33062.0
(sorry you'll have to find the post that refers to that question)
 
yet, even if I would grant any credibility to that calculator (I have expressed by concerns about the methodology), here is the outcome for me:

The underlying Framingham 5-years risk for the specified patient profile is 0.3% and the absolute Framingham 5-years risk while on abacavir is 0.6%

I do not smoke. I can not calculate yours because you did not answer the question about smoking...

using their calculator (not the Abacavir, but the general framingham) it gives, for me (again...)

The risk during the next    5 years    10 years
of CHD is:    1.4%   3.8%
of CVD is:    2%   5.3%
of MI is:    0.3%   1.1%

One major contributor the the risk is age. (no medication known, as of today)

Therefore one thing of interest is to compare ones risk the risk of the average person you meet in the street, by chance, and the only thing you can do is guess his/her age (usually, you can also figure out gender...)

The average risk 10 year risk for a 50 year old male (like me) is 11%

Why would you treat someone that has an average risk 3 times smaller than the average age/gender matched person. If you would do that , it would mean you put the entire nation under medication! (something big Pharmacy would love to do)

If you smoke, then your risk is higher, but, then, you know the recipe for reducing that risk and it would save you $$ ( and make Big Pharma and big Tobacco less rich...)

So here again, unless you have a combination of additional risk factor that you have identified, I do not understand your concern about your cholesterol and TG...

one side note: the fact that HDL > 60 is giving you 'bonus points' is rather recent discovery. There is still an academic discussion as some researchers think that this HDL>60 gives MORE bonus points than currently granted by the framingham scoring system.

One last thing though, my cardiologist recommended nonetheless that I take a stress cardio test once every 2 years (just in case...)

Hope this helps, Eric
(and hoops, I clicked on Notify instead of Modify to correct some typos, sorry for that)