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Author Topic: Criteria for Selecting Meds....  (Read 2034 times)

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Offline esper

  • Member
  • Posts: 57
Criteria for Selecting Meds....
« on: October 31, 2009, 10:28:44 AM »
Hi everyone, Iím new to the forum and looking for some guidance about what factors are considered in selecting a specific HAART regime. First, though, just want to say that this is a great forum Ė itís helped me tremendously to start to understand this disease and what to do.

If my question has been asked and answered a million times here, I apologize, but I havenít found what Iím looking for in my searches. Would really appreciate any input or a point in the right direction.

Quick background - I have decided to start meds soon, as starting sooner rather than later (when given the choice) seems to be the growing consensus. My doc isnít pushing, but is pretty consistent to say that earlier is better.  After my second set of numbers in Sept showed decrease in cd4 to (from 426 to 388) and a near doubling in VL (56k to 105k), and being 53 years old, Iíve decided to start.  Iím in good health otherwise; annual physical came back with cholesterol, EKG, liver, kidney, lungs, other blood work, etc. in the normal range. Iím going back for another round of cd4 / VL tests plus the genome / drug resistance test end November, and plan to start meds before end of year (barring a miracleÖ.).  So, Iím trying to get educated on how the specific drugs are selected for each patientís regime.

I understand that adherence is critical, so I know thatís a major factor in the selection process. What else should I make sure my doc and I discuss / consider when we sit to select the meds? Iím not expecting a foolproof methodology, but want to understand (before I meet with the doc) what is considered by the doc in selecting the drugs for me.  Thanks for any help. esper
tested positive June 26, 2009
06/26/2009-CD4 428: VL 56,200: 34.1%
09/28/2009-CD4 388: VL 105,000: 31.9%
11/16/2009-CD4 330: VL 242,000: 23.4%
12/11/09 started stocrin (sustiva) & truvada
02/02/2010-CD4 588: VL 204: 31.6%
04/27/2010-CD4 620; VL 154; 38.5%
08/25/2010-CD4 504; VL undet; 39.2%
11/16/2010-CD4 499: VL undet: 44.6%
03/01/2011-CD4 534: VL undet: 33.2%
06/01/2011-CD4 709: VL undet: 45.6%
12/11/2011-CD4 537: VL undet: 41.5%
06/10/2012-CD4 597: VL undet: 42.8%

Offline Inchlingblue

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Re: Criteria for Selecting Meds....
« Reply #1 on: October 31, 2009, 11:21:53 AM »
The number one place to begin when considering what meds to take is the results of the resistance testing.

Assuming you have no resistances and are able to choose from all of the available drugs, there is a "short list," IOW, the "usual suspects."

I started in July 2008 and did a tremendous amount of research online before deciding. I chose to start with Isentress and Truvada, even though my doctor wanted to go with either Atripla or a boosted PI (such as Reyataz/Norvir) with Truvada.

The bottom line is that all of the above-mentioned drugs are extremely effective at controlling the virus so it really becomes a question of weighing the pros and cons of possible side effects or lack thereof as well as considerations having to do with pill burden (how many pills a day) and dose frequency (how many times a day).

Isentress/Truvada is twice a day (the others mentioned above are once a day) but I'm very happy with my choice. I am not experiencing any side effects at all and went undetectable in about 2-3 weeks (I had a low viral load, about 9K).

It's very likely that Isentress will be approved for once a day use in the near future. Despite the twice a day dosing, I like the fact that there are no considerations as far as food (with Atripla, it's recommended to take on an empty stomach and with Reyataz you must take it with a meal).

Epzicom/Reyataz is also very good. One of the components of Epzicom has been linked to possible heart attack risk  but this is not definitive and has been disputed by follow-up studies.

EDITED TO ADD:

I just noticed that you're in Asia so that's another factor. As far as what I wrote above, I'm not sure what's available in Asia. 
« Last Edit: October 31, 2009, 11:28:16 AM by Inchlingblue »

Offline Ann

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  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Criteria for Selecting Meds....
« Reply #2 on: October 31, 2009, 12:57:32 PM »
Hi Esper,

It might help you to also read through two sections of the Lessons:

Things You Should Know Before Starting Treatment

and

The Big Treatment Questions

If you have any further questions after reading those lessons, feel free to come back here and ask away.

Good luck!

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline esper

  • Member
  • Posts: 57
Re: Criteria for Selecting Meds....
« Reply #3 on: October 31, 2009, 08:27:16 PM »
Inchlingblue and Ann, many thanks for your help. Ann, I shall read those sections from Lessons and come back with any follow questions, thanks very much (as I suspected my question has been covered already). Inchlingblue, you are right, most, but not all of the drugs, are available here - Thailand is where I stay - such as Atripla (maybe available sometime soon), am checking about Isentress but likely not here yet. I'll be getting the resistence test shortly and can then sort out any restrictions. I believe I've seen a site / document that does list the available drugs along with known / suspected side effects. Now to do some more reading, summarize the drugs and side effects, and be ready for the discussion with the doc. Thanks very much for your help, I appreciate it. All the best, esper
tested positive June 26, 2009
06/26/2009-CD4 428: VL 56,200: 34.1%
09/28/2009-CD4 388: VL 105,000: 31.9%
11/16/2009-CD4 330: VL 242,000: 23.4%
12/11/09 started stocrin (sustiva) & truvada
02/02/2010-CD4 588: VL 204: 31.6%
04/27/2010-CD4 620; VL 154; 38.5%
08/25/2010-CD4 504; VL undet; 39.2%
11/16/2010-CD4 499: VL undet: 44.6%
03/01/2011-CD4 534: VL undet: 33.2%
06/01/2011-CD4 709: VL undet: 45.6%
12/11/2011-CD4 537: VL undet: 41.5%
06/10/2012-CD4 597: VL undet: 42.8%

Offline Inchlingblue

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  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Criteria for Selecting Meds....
« Reply #4 on: November 01, 2009, 01:20:50 AM »
The generic form of Atripla is called Viraday and I think it is available in Thailand. Even if it isn't, I'm pretty sure the separate compnents are: efavirenz, tenofovir & emtrictabine.

Offline esper

  • Member
  • Posts: 57
Re: Criteria for Selecting Meds....
« Reply #5 on: November 01, 2009, 09:43:26 AM »
Thanks. yes all the Atripla components are available. My doc thought Atripla would be here by end of year. I will check on Viraday with my hospital.
tested positive June 26, 2009
06/26/2009-CD4 428: VL 56,200: 34.1%
09/28/2009-CD4 388: VL 105,000: 31.9%
11/16/2009-CD4 330: VL 242,000: 23.4%
12/11/09 started stocrin (sustiva) & truvada
02/02/2010-CD4 588: VL 204: 31.6%
04/27/2010-CD4 620; VL 154; 38.5%
08/25/2010-CD4 504; VL undet; 39.2%
11/16/2010-CD4 499: VL undet: 44.6%
03/01/2011-CD4 534: VL undet: 33.2%
06/01/2011-CD4 709: VL undet: 45.6%
12/11/2011-CD4 537: VL undet: 41.5%
06/10/2012-CD4 597: VL undet: 42.8%

Offline luckyone

  • Member
  • Posts: 36
Re: Criteria for Selecting Meds....
« Reply #6 on: November 03, 2009, 02:15:46 PM »
Hi everyone, Iím new to the forum and looking for some guidance about what factors are considered in selecting a specific HAART regime. First, though, just want to say that this is a great forum Ė itís helped me tremendously to start to understand this disease and what to do.

If my question has been asked and answered a million times here, I apologize, but I havenít found what Iím looking for in my searches. Would really appreciate any input or a point in the right direction.

Quick background - I have decided to start meds soon, as starting sooner rather than later (when given the choice) seems to be the growing consensus. My doc isnít pushing, but is pretty consistent to say that earlier is better.  After my second set of numbers in Sept showed decrease in cd4 to (from 426 to 388) and a near doubling in VL (56k to 105k), and being 53 years old, Iíve decided to start.  Iím in good health otherwise; annual physical came back with cholesterol, EKG, liver, kidney, lungs, other blood work, etc. in the normal range. Iím going back for another round of cd4 / VL tests plus the genome / drug resistance test end November, and plan to start meds before end of year (barring a miracleÖ.).  So, Iím trying to get educated on how the specific drugs are selected for each patientís regime.

I understand that adherence is critical, so I know thatís a major factor in the selection process. What else should I make sure my doc and I discuss / consider when we sit to select the meds? Iím not expecting a foolproof methodology, but want to understand (before I meet with the doc) what is considered by the doc in selecting the drugs for me.  Thanks for any help. esper


Offline luckyone

  • Member
  • Posts: 36
Re: Criteria for Selecting Meds....
« Reply #7 on: November 03, 2009, 02:18:33 PM »
im new to this site and cant figure out how to post a question so ive figured out how to reply to a post can u help me and tell me how to post a question .thank you ps. i am a little computer illiterate but will be learning fast.

Offline esper

  • Member
  • Posts: 57
Re: Criteria for Selecting Meds....
« Reply #8 on: November 03, 2009, 08:30:59 PM »
Hi luckyone, welcome to the forums. there is a help button above that will walk you through the "how to's" for the site....here's the link as well for the help area. hope that gives you what you need, if not let me know. esper
http://forums.poz.com/index.php?action=help
tested positive June 26, 2009
06/26/2009-CD4 428: VL 56,200: 34.1%
09/28/2009-CD4 388: VL 105,000: 31.9%
11/16/2009-CD4 330: VL 242,000: 23.4%
12/11/09 started stocrin (sustiva) & truvada
02/02/2010-CD4 588: VL 204: 31.6%
04/27/2010-CD4 620; VL 154; 38.5%
08/25/2010-CD4 504; VL undet; 39.2%
11/16/2010-CD4 499: VL undet: 44.6%
03/01/2011-CD4 534: VL undet: 33.2%
06/01/2011-CD4 709: VL undet: 45.6%
12/11/2011-CD4 537: VL undet: 41.5%
06/10/2012-CD4 597: VL undet: 42.8%

Offline bufguy

  • Member
  • Posts: 161
Re: Criteria for Selecting Meds....
« Reply #9 on: November 03, 2009, 10:08:10 PM »
I have been on Atripla for 18 months with great results. The number 1 consideration is once a day dosing for me. Very easy to remain adherhent. Although it is recommended to take on an empty stomach, I have no problem taking it after snacking.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

Offline esper

  • Member
  • Posts: 57
Re: Criteria for Selecting Meds....
« Reply #10 on: November 05, 2009, 05:42:58 AM »
bufguy, thanks, seems Atripla is a good choice and works very well for many people. Likely that's what I'll start with (I'll take the components or generic Viraday as Atripla isn't availabe where I stay as yet). I'm glad its working well for you.

I've been reading quite a bit of positive feedback on the Isentress plus Truvada combo (Inchlingblue's comment above), primarily about very little side effects especially related to nervous system, which can appear with efavirenz. Unfortnately Isentress isn't available here either, maybe next year.
tested positive June 26, 2009
06/26/2009-CD4 428: VL 56,200: 34.1%
09/28/2009-CD4 388: VL 105,000: 31.9%
11/16/2009-CD4 330: VL 242,000: 23.4%
12/11/09 started stocrin (sustiva) & truvada
02/02/2010-CD4 588: VL 204: 31.6%
04/27/2010-CD4 620; VL 154; 38.5%
08/25/2010-CD4 504; VL undet; 39.2%
11/16/2010-CD4 499: VL undet: 44.6%
03/01/2011-CD4 534: VL undet: 33.2%
06/01/2011-CD4 709: VL undet: 45.6%
12/11/2011-CD4 537: VL undet: 41.5%
06/10/2012-CD4 597: VL undet: 42.8%

 


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