SUSTIVA+ TRUVADA: HOW LONG DO THEY WORK FOR?

[newbie76]

I have started Sustiva+Truvada about 6 months ago and -luckily- I am not suffering from any side effects so far and my numbers are going the right way.

I have taken my pills late (1-2 hours late) on a couple of occasions, but never missed a dose.

I am aware that these 2 pills are what keep me alive right now and I don't want to risk screwing things up.

Now, what I want to know is: how long will this combo work for me? I know, I know, it's like asking how long is a piece of string. But there must be statistics, no?

I mean, we know on average how long it takes for the time between infection and the cd4 going under 200, so there must be statistics on how long on average this combo works for.

Also, if this combo fails am I right in thinking that a resistance test will be performed and I WILL ONLY HAVE TO CHANGE THE MED MY HIV HAS BECOME RESISTANT TO, AS OPPOSED TO BOTH?

Many thanks to whoever will want to reply!

M.

[minismom]

Newbie,
My dd (7yrs old) is also on Kaletra as well as susteva and zerit.  She was put on the med after having a genotyping done in 1/02.  Until her genotyping, she was on many medications and combos that weren't working for her.  Her VL was off the charts (literally) and wouldn't come down.  Plus, she was constantly getting gram negative bacterial blood infections.  I asked her doc last Tues. during her appt. what would happen if she began showing a VL again (she's been undetectable since 6/02). Her doc said what you said. They would do another genotyping and only change the ones that the virus was resistant to.  This regiment of meds has worked for our dd for over 5yrs.  They have some pretty nasty neurotoxic effects that we're just now learning about and dealing with.  But, she's still with us and that's what matters.

Good luck and welcome.  I'm new, too.

Mini's mom

[newbie76]

Thank yopu Mini's mum... although I am on Truvada and Sustiva, not Kaletra!

I read that Sustiva is quite easy to get resistance too, that's why I am particularly concerned.

[minismom]

Good grief, i'm so sorry!   Mini is also on sustiva - 300mg / day.  So far, she hasn't had any resistence to it - just a bunch of nasty side effects.

again, sorry...it's past my naptime.

mum

[vokz]

For what it is worth, this is my take …

Sustiva actually decays quite slowly, so being one or two hours late with just a couple of doses over six months should not be a problem.

At that high level of adherence, Sustiva is arguably far more forgiving than many of the other HIV drugs (including Truvada) .. provided you can get through the early period, before achieving an undetectable viral load, without developing any resistance to it.

With your level of adherence, whether or not you are one of the small minority of patients on a first-line therapy who develop resistance during that early suppressing stage is really down to luck (or bad luck).

If you have developed an early resistance, then that will probably manifest itself within a year or two. If you haven’t and you keep going as you are going now – and you don’t choose to change drugs - then there is no reason for you to think that you could not still be on Sustiva for even longer than the nine years that the drug has been available.

If you can keep the whole adherence thing nailed (which you seem to be doing) then you are doing all that you can do to influence whether or not you develop resistance to Sustiva.

You may find statistics out there; but if you do, please remember that they will include people who haven’t been as adherent as you are (either because they haven’t been motivated, have taken treatment breaks or have had other health events that have prevented them), so the statistics still wont really give you the answer you are looking for. I have even seen claims by some doctors (who must have unusually adherent and treatment naïve patients) who claim never to have had a single treatment failure on Sustiva.

The real problem with Sustiva relates to what happens when you have habitually poor adherence, or stop taking the drug – not what goes on when you are adherent and have an undetectable viral load – and that it can take many weeks (even months in some extreme cases) for Sustiva to clear from your bloodstream. During all of that time, there can be ineffective sub-therapeutic levels of the drug that are an open invitation to resistance.

Be concerned enough that you are motivated to keep those excellent levels of adherence; but beyond that try to put the other worries to the back of your mind, because at that level you are stressing about relatively low risk factors that are way outside of your control.

Maybe my understanding is way off the mark .. in which case I will be more than happy to stand corrected.

Mark

[newt]

What vokz said  - matt

[newbie76]

Vokz, thank you for your reply... I guess my worry was a bit motivated by the fact that I started from a relatively high VL (110k) and that at the last bloodtest I was still detectable. But your reply did put my mind at rest. Now I just have to hope to be undetectable at my next test which will be sometimes next month.

Newt... your new pic... whoa!!! 

[vokz]

Newbie,

I would be willing to make a sizeable bet that you were undetectable before you even got those last results

[newbie76]

Oh and another thing that I would like to know. Is Sustiva+Truvada (or Atripla) the only once-per-day combo available at the moment. That is, if I were to develop resistance to this combo, my other options would be all -at least- twice daily?

[newt]

By no means

As per the approved use:

Reyataz boosted or unboosted (+ 2 nukes) is a once-a-day PI

As per practical use, many people (but not all) do well enough on a selection of other drugs 1 x day, especially if viral load is already less than 50 copies/mL of blood.

Viramune (NNRTI like Sustiva)
Kaletra (PI)

for two

The nukes need to be either Truvada (tenofovir + FTC) or Epzicom (abacavir +3TC) or ddI + either tenofovir or abacavir or FTC or 3TC << but why ddI?

Tis likely if for some reasons Sustiva was wiped Viramune also wold fall away (class resistance).

- matt