Change a winning combo?

[kiwilondon]

Hi all.
I'm new here, so thought I'd see what you guys think of this....
Last time I met with the doc (not one I'd met before), she suggested I consider changing from sustiva/combivir to sustiva/truvada. No big reason, just the change to once a day and a bit of caution around prolonged use of AZT. I've been on meds for 10 years, the last 4-5 on sustiva/combivir. All through, my results have been great - been undetectable from the word go and my cd4s now sit in the 700-1000 range.

My instinct is not to mess with success. However, the doc was unimpressed with my casual approach to the timing of taking my meds - I take them breakfast and dinner, whenever that may happen to be. In her view, a once a day regime would be 'more suited to my lifestyle'. Putting aside that I felt a bit affronted that in the first meeting she should lecture me on how I take my meds, I decided to give the suggestion some consideration. As part of that I'd be interested in the experiences of other here. Anyone made the same sort of switch?

[kiwilondon]

oops, said I was new...wrong thread, sorry!

[mrtallguy]

Hey Kiwi....Welcome to the AM Forums!!
I have been participating for about a month and the people are amazing.....a true gathering of angels.  As with anything, the more you give (participate) the more you get (responses) so know that your decision to be here is acknowledged and appreciated!   I have not changed meds yet but I made what I thought was a simple change...started on Truvada (morning) and Sustiva (night) and then after 5 months changed to Atripla which is the same meds all in 1 pill which I took at night.  I have always had some issues with insomnia but taking everything at night put the insomnia into "overdrive".  So I switched back to the split regimen but the crazy insomnia continued....making that simple change flipped a switch in my system with no "going back".  So now I still take the Truvada in the morning along with the Sustiva in 3 doses (200mg ea) to minimize the dizzy side effects.   So I am getting to know my HIV better....she is a bitch who does not like to be slapped around!

So I say if your current regimen works stick with it....a "simple" change may not end up so simple after all.  You have to do what is right for YOU....and you may want to interview some new docs....sometimes we forget that WE are the customer!  (Damn it!)

Be Well....

CRAIG

[Miss Philicia]

While I found the casualness of your statement "whenever that may happen to be" kind of... well, casual for adherance one find it hards to argue with the numbers your presented.  Obviously your "whenever that may happen to be" is fairly constant.  I've not ever heard, in my own experience, of just changing meds when they're working but maybe I've missed the boat on that one.  I've been taking meds for 14 years.

[newt]

Hello

Let your doc be affronted. The results speak for themselves. Your doc's concern on timing seems kinda theoretical given 5 years undetectable, but a sound theory, concerned she will be about a slow evolving nuke resistance cos of slightly elongated dosing interval for the Combivir, which can creep up unnoticed.

Me, though, would not be worrying about this too much, more thinking about the long-term side effects.  These are well known, and there is now evidence that AZT affects heart health (partly by damaging the muscle) and increases the risk of diabetes, which is obviously something to consider if you see yourelf getting to zimmer frame age. But not everyone gets them, and you give no indication that AZT in Combivir is causing you any problems. I agree, don't fuck with an effective combo except for a very good reason. I do think the documented effects of long-term AZT use are a good reason from a long term point of view, something to think about, but from what you say, not instantly and immediately compelling.

Stavudine, didanosine and AZT pose diabetes risk in D:A:D study

- matt (in snowbound Brighton)

[blondbeauty]

I am on my first combo. This is only my fifth month on it but I can tell you it is extremely easy to adhere to it. I take both pills at the same time 00.00 hours. I call it Cinderella time. Sustiva is more likely to cause side effects than truvada, and you are already used to it. I think changing combivir for truvada (a one a day regime) can only improve your quality of life.
Juan

[kiwilondon]

hey guys 
I feel such a dumb newbie! I've only just seen your replies...so, I haven't been ignoring you I just hadn't found you.
Thanks very much for the warm welcome, Craig Interesting what you say, because that's my concern...that a seemingly simple change that looks good turns out to have unintended consequences. I don't want to end up being worse off than I am now, afterall, I have it pretty damn good so why give it up.
But then you get the points raised by Matt...so what's a boy to do??  10 years on AZT, 10 years with no problems at all with it and 10 years undetectable...how big a worry is diabetes and heart disease in the face of that?
Don't know that I'm any closer to knowing what I want to do yet!
cheers
David

[newt]

An ECG and simple blood/urine tests should be able to say if heart/diabetes is a serious consideration.  If it's been several years and no side effects, then why change? is a damn good question. Many of these things are driven more by prescribing fashion, albeit based on some science, than individualised clinical assessment. Although the long-term side effects are relatively common, they are not universal. If you don;t change now you can always change later (and if you do, change back) - matt

[mrtallguy]

Hey Kiwi....glad to know that you found these replies...or better yet, how to access them!

Matt....I'm undecided as to which is more attractive...your knowledge of this disease, your compassionate replies, or your devilish good looks....I'll call it a tie!

Be Well....

Craig

[mjmel]

Last time I met with the doc (not one I'd met before), she suggested...

Is it possible for you to get any feedback from the previous physician(s) you've had.

[twofires]

upon re-settling in a new area, my new doctor wanted to totally undo a well-working combo and put me back on an old trio. No real reason why, he just wanted to.

After 3 sets of labs during the following months he finally shut up about it, totally and completely to the point where he did not even want to talk about *why* he prefered some drugs over others.

he also accused me of being "suspicious" when I was talking about the confusion between Ranitidine/Famotidine/Previcd/Zantac/Nexium etc (ad nauseum) for acid reflux. As I may *only* take Ranitidine with my Reyataz/Truvada/Norvir I was saying how strangely difficult it is to buy OTC. Suspicious?? I better be, otherwise I'll buy be wrong damn GERD meds and counter-act my HIV meds, right?

Some doctors are just assholes...

I fired him....