Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz

[Okealyshire]

Hey everyone...happy to see the community here is still going strong. Missed reading the threads and participating while I was dealing with some extended job issues...got laid off, fortunately found another great job. Less travel, more personal time, all's good these days.

The insurance plan I'm on now has higher prescription copays, so to save a bit of money I looked for possibilities to get off Norvir so that I can reduce the number of prescriptions from three to two. After studying the December 2009 guidelines, it seems the only other choice for once-daily dosing is Epzicom and Reyataz (I'm resistant to NNRTIs). I chatted with my IDD about switching from Truvada to Epzicom. Many of his other patients are on this regimen and doing well, so I had the HLA-B*5701 test. Got the results today: negative. Yay!

Anyone else on this combo? What do you think of it? I'll place my first order next week.

[Inchlingblue]

I have a close friend on it but he started out with a very high vital load so the doctor wanted to include Norvir and has kept him on it for some reason, so he's on Reyataz/Epzicom/Norvir.

He's doing great, went from 700K viral load and about 250 CD4s to undetectable and about 800 CD4s and feels great and looks great. You might want to hear from people on just Reyataz/Epzicom but I figured I'd share his experience just in case.

As far as NNRTI resistance, Intelence apparently works in many cases where there is previous NNRTI resistance.

Keep in mind that Isentress is likely to be approved for once a day dosing in the near future.

Here is a recent article about dropping the Norvir for those on Reyataz/Epzicom/Norvir:

Switch From Norvir-Boosted to Unboosted Reyataz Safe and Effective

http://www.aidsmeds.com/articles/hiv_reyataz_atazanavir_2351_16988.shtml

[Okealyshire]

I saw that article, which was the motivation for me to do the research about making the switch. I read that Epzicom has moved from "preferred" to "alternate" status because concerns about possible increased heart attack risk; since other studies don't confirm this claim and there's no history in my family of heart attacks, I feel comfortable about making the switch.

When Isentress is approved for once-daily dosing, I might consider another change, this time to Epzicom + Isentress. I think I'd prefer this over Truvada + Isentress because the bone and kidney issues related to tenofovir concern me. Plus, getting off PIs completely has a certain appeal -- I'm 43 and still very twink-like, I'd like to keep the lipids in check! hahaha...

[Inchlingblue]

I'm also not convinced about the abacavir and heart attack connection. Below is a good article in case you haven't seen it already.

I'm on Isentress/Truvada, since July 2009 and I'm seriously considering switching the Truvada to Epzicom for the same reasons you mention.

LINK:

http://www.aidsmap.com/en/news/B125FC65-35B6-4347-9394-306E6B1F09F6.asp

[ad2san]

hi guys,

i went to my quarterly appointment today. I am may on TVD + Reyataz + Norvir (first therapy). Blood analysis are fine. I had some adaptation problems in the first months of taking the meds but I am doing fine, except that I have terrible problem sleeping, without lunesta I just can't.
My doc searched for the reasons for not falling/staying asleep, including sleep lab, nothing.
So he suggest to switch Truvada with Epzicom/Kixeva.
I am a little bit puzzled. Actually, on HIV side, the combo is working ... I am not found about going for an "adaptation round" again by change the combo ...
Any experience in switching ? Is sleep with Epzicom/Kixeva good (for those who have problems ?)
Cheers

[Okealyshire]

Any experience in switching ? Is sleep with Epzicom/Kixeva good (for those who have problems ?)
Cheers

Tomorrow is my last dose of the Truvada + Reyataz + Norvir combo. Once I start the Epzicom + Reyataz combo, I'll report back my experiences.

[Forever England]

Tomorrow is my last dose of the Truvada + Reyataz + Norvir combo. Once I start the Epzicom + Reyataz combo, I'll report back my experiences.

Not wishing to hijack this thread, but I'd be curious to hear how you do too. I switched from Atripla at 23:30 to Truvada+Reyataz+Norvir at 21:00 last week and am finding it hard to fall asleep at night and INCREDIBLY hard to wake up the following morning.

[risred1]

Definitely interested in your experiences on this change. I'm considering it as well.

Thanks!! Looking forward to it.

[flip408]

I was on trial with reyataz norvir and either truvada or epzicom.   Turns out I am on epzicom, so I am thinking I could stop the norvir and continue with reyataz and epzicom.?

Just had my highest CD4 430 and 16 %, and vl <50 from 11/2006.   My providers say "if it ain't broke don't fix it"  and yea I have never had a single side effect from this my first combo. 

What if ADAP crumbles, reyataz and epzicom are cheaper.  Are there long term effects from Norvir I could avoid?

 

 

[Okealyshire]

So I've been on the new combo for seven days. A few observations...

I haven't noticed any changes in sleep patterns; I've always been a light sleeper, though, and it isn't uncommon for me to wake up during the night. Occasionally I'll take a 1 mg alprazolam (Xanax) when I sense that I'm not going to sleep well.

My, uh, gas production has reduced, which is certainly a good thing! No additional symptoms have appeared. When you drop the Norvir from this combo, you have to increase the Reyataz dose from 300 mg to 400 mg (two 200 mg capsules). I haven't noticed any increase in yellowing.

Probably the most curious thing is the cost differential. Using drugstore.com as an example, here are prices without insurance for 90 days:

Truvada, 90 tablets -- $2975.34
Reyataz 300 mg, 90 capsules -- $2962.78
Norvir 100 mg, 90 capsules -- $839.98
------------------------
Total -- $6778.10

Epzicom, 90 tablets -- $2660.29
Reyataz 200 mg, 180 capsules -- $2952.54
----------------------
Total: $5612.83

I really don't understand how increasing the daily dose of Reyataz from 300 mg to 400 mg ends up costing a few dollars less! Even more curious is how my insurance company prices them. Truvada is a preferred drug, Epzicom isn't. So my co-pay for the Epzicom is a bit higher. Since my co-pay for the Reyataz didn't change, dropping the Norvir from the regimen results in a lower total co-pay. But still, overall my insurance company is saving a whole lot (*) after I made this change, I wish my savings were greater.

(*) The conspiracy theorist in me wonders if my insurer gets a kickback from Gilead but not from GlaxoSmithKline? Hmm...

[risred1]

any of the classic symptoms?

headache, fatigue, digestive, rash, fogginess?

[Okealyshire]

headache, fatigue, digestive, rash, fogginess?

Nope, none at all. Very happy with the change, though I know it's been only a week so far.

[Okealyshire]

Second week on Epzicom + Reyataz combo. Absolutely no symptoms at all, I'm very pleased with the outcome. Still supplementing with vitamin D + calcium because the research doesn't appear conclusive about whether bone loss is specifically because of Tenofovir in Truvada or a more generalized HIV response.

Looking forward to forthcoming research on Epzicom + once-daily unboosted Prezista. If there are good results from that, I'd consider another switch -- mainly to avoid the food and H2 limitations with Reyataz; fortunately it appears I'm not afflicted with jaundice.

[Inchlingblue]

Second week on Epzicom + Reyataz combo. Absolutely no symptoms at all, I'm very pleased with the outcome. Still supplementing with vitamin D + calcium because the research doesn't appear conclusive about whether bone loss is specifically because of Tenofovir in Truvada or a more generalized HIV response.

According to Dr. Gallant "mild loss of bone density occurs initially with all ART regimens but is not progressive." This is good to know although it's still unclear based on that statement if tenofovir causes even more of it.

LINK:

http://www.hopkins-hivguide.org/q_a/patient/antiretroviral_therapy/antiretroviral_agents/nucleoside_and_nucleotide_reverse_transcriptase_inhibit/isentress___epzicom_.html?contentInstanceId=512496