Possible Drug Regimen change?

[smalltown66]

I have read several articles lately that seem to suggest that taking a protease inhibitor such as Reyataz along with Truvada often means you are more likely to develop kidney toxicity from the Truvada. Has anyone heard of this or read about whether this is true.

About a year ago I was diagnosed with stage three Chronic Kidney Disease. At that time my Doctor and I talked about whether or not I would have to change my drug regimen. We decided not to change anything for a period of time. Now that I am reading all this information about combining Truvada with protease-inhibitors may cause you to be more likely to develop Kidney toxicity.

Since I do have kidney disease should I insist to change regimens and completely get rid of the Truvada, or should I stop taking the Reyataz and choose another class of drugs other than a protease inhibitor?

Any have had this experience or has knowledge of this? I would appreciate any information any one can share.


Counting my blessings for my forum friends!
Thanks Smalltown66

[rondrond]

Smalltown,

I was not taking your exact drug regime, but I was on Truvada/Viramune  My creatnine was increasing slowly, which the doctors kept track of through my bloodwork.

When they confirmed it was not going to stop, they took me off of the Truvada. Not having taken Reyataz, I have now idea where it would fit into the picture.

There's a section on the home page about drugs and their interactions: it never hurts to check on these things.

Hope you and your doctor find a solution.

[AndyArrow]

Hi Smalltown,

I'm sorry I don't have any experience myself to relate in this mater.  I just wanted to wish you luck and hope you and your doctors find a drug combination that your kidneys can tolerate easier.

Hugs,
AA

[Miss Philicia]

I don't know about this.  I do know that the Tenofovir component of Truvada has seen some mild kidney issues, though going from this and your older posts I know that you issues are more than mild.  I also know that dosing adjustments can be made in such cases.

However, I'm very hesitant to state that these issues are prevalent.

Otherwise, knowing this is prudent (though any doctor should know it). Personally I was on Kaletra and Viread (then Truvada of which that's a component) for five years with no issue, and have been on Prezista (another PI) now for 3 years with no issue, so that's a total of 8 years on PI's plus Viread/Truvada which is longer duration exposure to an HIV medication than any I've otherwise had:

source

Viread decreases the concentration levels of Reyataz. In addition, both Reyataz and Kaletra increase Viread concentrations. Higher Viread concentrations could increase the risk of Viread-associated adverse events, including kidney disorders. Patients receiving Reyataz and Viread should be monitored for Viread-associated adverse events. When taken with Viread, it is recommended that Reyataz 300 mg is given with Norvir 100 mg (all as a single daily dose with food). Reyataz without Norvir should not be taken with Viread. Do not take with Truvada or Atripla, since Viread is in these medications. You should not take Viread with Hepsera, a hepatitis B treatment.

[Giblarry]

Smalltown. 

I'm on an entirely different regimen.  Prezista, Intelence, Epizicom, Selzentry.

I too am experiencing lowering efgr (kidney function) and raising creatinine.  In fact, I'm not too far away from kidney disease. 

What we're seeing, for reasons nobody can seem to pin down, is a general trend toward kidney implications primarily in long termers and older folks, but some of the newer and younger set are also drifting toward renal troubles.  I think the establishment is just now beginning to try to get a handle on this, and no one regimen, at this time, has proven to change the trend. 

I'd get with my specialist and discuss what benefits other regimens might bring.  My guess, though, is that the specialist won't recommend changing.  We and they simply do not know.  This could be, probably is, a syndrome tied to these later versions of meds.  Much like the lipos were with the older versions.  Still, renal failure in HIVer's has always been around.  It's just become a lot more prevalent. 

A diabetic diet might help reduce the proteins in your urine and reducing glucose in general throughout your system.  Too much of both, however, does seriously impact the kidneys. 

Sorry I can't give you more specific answers. 

Very best,
Gib

[Miss Philicia]

This could be, probably is, a syndrome tied to these later versions of meds.  Much like the lipos were with the older versions.  Still, renal failure in HIVer's has always been around.  It's just become a lot more prevalent. 

Can you back any of this up?  It's a bit of an alarmist comment to make, or me to accept, with something more than an assertion like this.

[Giblarry]

Can you back any of this up?  It's a bit of an alarmist comment to make, or me to accept, with something more than an assertion like this.

http://emedicine.medscape.com/article/246031-overview

http://www.aidsinfonet.org/fact_sheets/view/651

It's all over the net.  Google it. 

Is it a syndrome?  No one knows yet, which I clearly state in my post, but the lipos weren't identified as a syndrom, either, until we hollered enough to be heard.  Fortunately, kidney studies are already underway. 

Alarmist?  I don't think so.  After all, when you have AIDS you're about as alarmed as you can be.  To be fore warned is to be fore armed.  I work a lot, locally and nationally, in AID advocacy.  I know a lot of infected people, and I see how many of them are experiencing kidney problems. 

[Miss Philicia]

Help me out here and cite the relevant passages that support your particular assertion about the newest meds causing kidney issues on the same magnitude that meds from the 90's caused lipo, as that's what you previously stated specifically, and what I quoted from you.

Alarmist?  I don't think so.  After all, when you have AIDS you're about as alarmed as you can be.  To be fore warned is to be fore armed.  I work a lot, locally and nationally, in AID advocacy.  I know a lot of infected people, and I see how many of them are experiencing kidney problems.

Yes dear, I've been infected for over 20 years.  I know tons of people and I don't know see kidney problems from viread on the save level as zerit-induced lipoatrophy, which I also have had for a decade.

[Giblarry]

Help me out here and cite the relevant passages that support your particular assertion about the newest meds causing kidney issues on the same magnitude that meds from the 90's caused lipo, as that's what you previously stated specifically, and what I quoted from you.

Yes dear, I've been infected for over 20 years.  I know tons of people and I don't know see kidney problems from viread on the save level as zerit-induced lipoatrophy, which I also have had for a decade.

Well, this could easily turn into an argument, which I will not do.

I clearly state that research into this is in it's infancy, and I've made no bones about the fact that there are no abstracts that I know of on this.  So, you got me.  Can't cite any specific packages.  I can't prove it and you can't disprove it. 

Good for you and good for your friends.  Two of us in my household and many HIVer's I know are experiencing kidney disfunction to some degree.  It was minor for almost all this time and is now suddenly it seem to be affecting a highly disproportionate number of infected people ... which is all I've ever said.  I say what I say so that people will know because kidney disease is like diabetes, by the time you're symptomatic it's probably too late. 

I'm glad you know tons of people and please don't call me 'dear'.

[megasept]

Since I do have kidney disease should I insist to change regimens and completely get rid of the Truvada, or should I stop taking the Reyataz and choose another class of drugs other than a protease inhibitor?

hi. If Truvada is not the primary culprit, how about Insentress + Truvada, my combo?

good health!   
-megasept