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Author Topic: Truvada & Reyataz w/o Norvir  (Read 3701 times)

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Offline sweetamadeo

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Truvada & Reyataz w/o Norvir
« on: April 18, 2007, 04:26:19 PM »
This will be my first go at taking meds.  While researching what kind of side effects I could look forward too, I noticed Norvir is used with Truvada/Reyataz to boost the amount of Reyataz in the bloodstream.
This is all overwhelming and I'm an emotional wreck.  My doctor is never available to talk and i always feel I know more than he does.  The nurse won't or can't answer any questions about the meds, her response is always "the risk of side effects outweigh the risk of no meds at all."

How important is the Norvir and if so what do I do?

Offline newt

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Re: Truvada & Reyataz w/o Norvir
« Reply #1 on: April 18, 2007, 06:07:03 PM »
Hello

Both unboosted and boosted Reyataz are acceptable.  Except...

1. The tenofovir in Truvada lowers the level of Reyataz, perhaps to a too low level. If it is to be Truvada then boosting is advisable.  If another nuke pair, eg AZT+3TC (Combivir) or abacavir+3TC (Epzicom) is used then unboosted is okay.

2. People on boosted Reyataz get better results long-term than on unboosted. Why? The boosting lengthens the time that Reyatz stays in the body at an effective level, which means that adherence is not so time critical, and an extra hour here or there when taking it is not so important.  It also raises the lowest dose of the drug. This helps prevent resistance and treatment failure.

For complicated reasons, boosted Reyataz with truvada is a good combination lipid (blood fat) wise.  PIs tends to raise lipids, which increases the risk of heart disease and diabetes. Reyataz is less likely to raise lipids. Paired withTruvada, it is even less likey to do so ( a magical property of the tenofovir in Truvada).

Short answer: if you wanna use Truvada, the go boosted.

matt (on boosted Reyataz/Truvada and undetectable) the newt
"The object is to be a well patient, not a good patient"

Offline sweetamadeo

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Re: Truvada & Reyataz w/o Norvir
« Reply #2 on: April 18, 2007, 08:03:02 PM »
Thank you so much Newt  :) 
I will tell my doctor Tuesday I want the boost.  Its good to know that I will be fine taking just the two while I wait for Norvir to come thru the state. 
Thanks again, I'm very happy to have stumbled upon this website.

Offline risred1

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Re: Truvada & Reyataz w/o Norvir
« Reply #3 on: April 18, 2007, 08:49:12 PM »
If you feel you know more about medications than your doctor, then you need to consider changing specialists.

The fact that he did not discuss or mention boosting Reyataz when paired with Truvada, something that is well know in the current treatment guidelines, suggests that you may know more than the doctor you are seeing.

Finding a good doc can be hit or miss. I suggest if there is a Strength in Numbers branch near you or a local support organization, you can poll them to see who recommends a doctor.

My doc works at a university hospital. i picked him out of a list of doctors from my Health Care Provider. It has turned out well. He is up to date on the latest research, attends the major conferences, and takes enough time at our appointments to discuss what's going on with my blood work, what has happened over the last 6 months, provides a brief physical, talks to me about getting my liver scanned again, and discusses the latest drug options. (he is very interested in the integrase inhibitors.)

He's not perfect, but I trust he is up to date and he is very interested in providing the "right" strategy for approaching treatment.

If your not feeling comfortable, and this causes greater unease, I really think you should try another specialist if you can arrange it.

By the way, did you have a Resistance test done? If you haven't, its probably a good idea. They do take a while to spit out the results. (in University of Pennsylvania, it took a month!) But the Resistance test can show mutation if any, and guide the drug choices from the get go. If you haven't, perhaps another reason to find another doc?

I'm sure you'll do fine, most people do pretty well on the first treatment run. There are stories, and there are issues and there are toxicities. You may be able to mitigate the most common side effects such as diarrhea and other side effects may pass with time. Long term effects due to mitochondrial toxicity is a more complex issue, you might want to bone up on nutritional supplements and plan on getting regular exercise! You don't always hear about folks that do well on forums, so take heart, toady's medicines are better than the old ones, and the new ones may be better still!

risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

Offline SouthSam7

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Re: Truvada & Reyataz w/o Norvir
« Reply #4 on: April 19, 2007, 01:48:07 AM »
I'm reading the Reyataz information and it plainly says:
Reyataz 300 mg + Norvir 100 mg once daily in TREATMENT-EXPERIENCED PATIENTS
Reyataz 400 mg  once daily UNBOOSTED IN THERAPY-NAIVE PATIENTS.

The Reyataz information gives the above directions regardless of other hiv meds (makes no mention of special directions for Truvada patients, etc.)

Therefore, DO NOT boost the 400 mg of Reyataz if you have never taken HIV meds before.

Talk to your doctor, or go to reyataz.com.

Offline SouthSam7

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p.s....
« Reply #5 on: April 19, 2007, 01:58:58 AM »
p.s. If there is something I'm missing about the Truvada/ Reyataz combination and when to boost with Norvir based on other hiv drugs, please tell me where you got your information. 

The information I quoted above is from literature that is brand new.  My clinic received it today from Reyataz.  Why would special boosting information not be in this new brocure?

Sam

Offline newt

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  • the one and original newt
Re: Truvada & Reyataz w/o Norvir
« Reply #6 on: April 19, 2007, 03:17:51 AM »
On the tenofovir/Viread/Truvada point, from the Reyataz prescribing information:

"Tenofovir may decrease the AUC and Cmin of atazanavir. When coadministered with tenofovir, it is recommended that REYATAZ 300 mg be given with ritonavir 100 mg and disoproxil fumarate tenofovir 300 mg (all as a single daily dose with food). REYATAZ without ritonavir should not be coadministered with tenofovir."

AUC = area under the curve, a measure of drug exposure over a dose. Cmin = lowest level of the drug in the body - this needs to be above a certain level for the drug to be effective continuously, and drug levels below the necessary Cmin may lead to resistance.

BMS, the maker of Reyataz, issued a "Dear Doctor" letter on 8 August 2003 on using Viread with Reyataz (this will therefore apply to Truvada aswell):

TREATMENT ALERT: Important new pharmacokinetic data for atazanavir sulfate (Reyataz™) in combination with tenofovir disoproxil fumarate (Viread®) - also elsewhere eg on The Body etc.

- matt
"The object is to be a well patient, not a good patient"

Offline newt

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  • the one and original newt
Re: Truvada & Reyataz w/o Norvir
« Reply #7 on: April 19, 2007, 03:44:18 AM »
PS - US guidelines for adult and adolescent HIV treatment now give boosted Reyataz + either Truvada or Combivir as a preferred first-line combination and unboosted Reyataz + either Epzicom or ddI+3TC as an alternative.

US HIV treatment guidelines
"The object is to be a well patient, not a good patient"

Offline Pippet

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  • Posts: 135
  • Life is drawing without an eraser.
Re: Truvada & Reyataz w/o Norvir
« Reply #8 on: April 19, 2007, 11:54:47 AM »
Thanks for this post.  My last doc took me off of Norvir due to Jaundice, and left me taking Truvada and Reyataz (400mg unboosted).  I searched everywhere and could not find any literature that didn't advise against this combo.  Of course my doc couldn't even ease my worries, he just told me it was a perfectly acceptable combo, and left it at that.  I had to switch docs to find someone I could actually talk to about my concerns.  He switched me to Kaletra, Truvada.
I am still curious about this, because I found it to be a very tolerable combo.
Thanks.
Keep the info coming, Pip
« Last Edit: April 19, 2007, 12:16:23 PM by Pippet »
Diagnosed Aug. 2006
CD4 246, VL 202,000
Started Truvada/ Viramune 11-23-06
Taken off meds 12-06-06 (Bad Rash)
Started Truvada/ Reyataz, Norvir 1-18-07
Taken off Norvir 3-1-07 (Jaundice)
New doc 3-22-07
CD4 229  VL 1031
My latest cocktail...  Truvada and Kaletra (4-6-07)
CD4 289 VL 350 (5-15-07)
CD4 308 VL 115 (8-06-07)
CD4 349 VL 511 (11-5-07)
CD4 489 VL 383 (2-4-08)
CD4 483 VL <50 (5-6-08) YEAH
CD4 545 VL 108 (9-12-08)
CD4 409 VL <48 (1-27-09) YEAH
CD4 505 VL <48 (5-20-09)
CD4 385 VL <48 (9-15-09)
CD4 609 VL  159 (2-28-10)

Offline sweetamadeo

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  • Posts: 3
Re: Truvada & Reyataz w/o Norvir
« Reply #9 on: April 19, 2007, 01:43:24 PM »
Thank you risred.  I haven't had a resistance test, something I will mention.
I spoke with a nurse today at a clinic a county over.  She wasn't very specific but she said that "they've found" that unboosted Truvada and Reyataz is ok since this is my first therapy.  I asked if that meant I had to be more careful with taking my dosage around the same time and she said yes. 

Offline newt

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  • the one and original newt
Re: Truvada & Reyataz w/o Norvir
« Reply #10 on: April 19, 2007, 01:52:32 PM »
Your nurse/clinic is contravening FDA, CDC and manufacturer's advice ...

- matt
"The object is to be a well patient, not a good patient"

Offline risred1

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  • Posts: 419
  • My Source for Supps - www.newyorkbuyersclub.org
Re: Truvada & Reyataz w/o Norvir
« Reply #11 on: April 19, 2007, 02:08:49 PM »
From Aidsmeds.com in the Drug descriptions area.

Take with a light meal. For patients who have taken anti-HIV drugs in the past, the recommended dose is 300mg Reyataz plus 100mg Norvir (all as a single dose with food). This combination of Reyataz and Norvir is also recommended for patients who are using either Viread (tenofovir) or Sustiva (efavirenz) in a drug regimen that involves Reyataz.

Additionally, first treatment guidelines state this as well.

I can understand that another drug with the costs of Norvir may be undesirable, so your taking really 4 meds, Truvada is a combo and Reyataz and Norvir. Reyataz can be taken in a two pill set combo, Epzicom and Reyataz.

The attitude towards using a resistence test 1st has changed over the last year or so. The initial concern was that the resistence test would not pick up mutations and that the vast majority of infections were Wild type. My understanding is the test has gotten better and wild type, while still a big majority, isn't so much a given any more. So, if resistence test is administered, it is to provide information for you and your doctor so that you can be sure to start with a treatment that will work, without guessing at it.

I wouldn't have an issue with using the Truvada/Reyataz/Norvir combo, but the norvir takes some of the advantage of Reyataz as there are lipid issues associated with the Norvir. I am personally very interested in Reyataz as I do have a bit of a lipid issue at this time. So when I go on meds, it will be my first preference. The trick is to use it unboosted with Epzicom. Epzicom has its issues as well, but if ones kidneys aren't impacted by Epzicom, then it is well tolerated.

Regardless, take stock that Truvada and Reyataz is probably a good combo. You just may need to boost with the Norvir to make it, hopefully, a long term well tolerated treatment.

I am not a doctor...

Sometimes doctors aren't doctors as well...(sorry to say.)




risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

Offline SouthSam7

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  • Posts: 428
Re: Truvada & Reyataz w/o Norvir
« Reply #12 on: April 19, 2007, 02:51:21 PM »
I just read the info from http://www.thebody.com/content/art13835.html.  It is scary to know that information is out there, yet I didn't know anything about it.  Worse, the Reyataz literature I got from my doctor yesterday was brand-new and it didn't mention anything about Reyataz and tenofovir interactions.

Thank you all for getting me the information.

I think I'll stick with what I'm on for now.

Offline standinbymyself

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Re: Truvada & Reyataz w/o Norvir
« Reply #13 on: May 01, 2007, 01:24:44 AM »
First time posting to any forum.  well i have been poz for 10+ years and i just found out im resitant to my meds sustiva and combivir took them for 7 years now the doc gaveme prezista novir  and videx and zerit.
My problem i have read some bad results from videx and zerit. I called him but he said videx and zerit are very common can anybody please give any kind of advice I am really scared about these meds .

Offline Matty the Damned

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Re: Truvada & Reyataz w/o Norvir
« Reply #14 on: May 01, 2007, 01:54:12 AM »
Standin,

Welcome to the Forums!

MtD

Offline newt

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For standinbymyself...
« Reply #15 on: May 01, 2007, 06:27:02 AM »
"The object is to be a well patient, not a good patient"

 


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