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Author Topic: new regimen ?????  (Read 1907 times)

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Offline Jeri

  • Member
  • Posts: 4
new regimen ?????
« on: September 30, 2007, 01:25:33 PM »
I'm changing meds because of resistence...
New regimen  SUTIVA,Viread and Kaletra(liquid)
I'm sitting here looking at meds
Should I take them, ok yes I have not many choices, but how do I take them
And they all have possible side effect of lipoathropy(Ihave no more fat to loose)
This is about to be too much 

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: new regimen ?????
« Reply #1 on: September 30, 2007, 05:12:01 PM »
Hello welcome

1. although I AM SURE that the package inserts say lipoatrophy in the side effects list these drugs are not associated with fat loss in real life taking the things situations, except perhaps if you are a woman (of African origin) when fat loss regardless of combo is uncommon but noted .  Lipoatrophy as to be included as a possible side effect in the Sustiva and Kaletra packaging cos when taken with old nukes like AZT and d4T people lost fat, but Sustiva and Kaletra per se, not really any big association with fat loss.

2. Why Kaletra liquid?

3. What dose of Kaletra? it often needs adjusting with Sustiva.

4. Why no 3TC or FTC? Regardless of resistance this seems a good idea, esp. as Viread is more potent against strains resistant to 3TC/FTC.

5. Do you have the results (numbers and letters) of your resistance test. If you want/can post them you will undoubtedly get an informed opinion here on whether the combo is up to scratch.

6. Choices..several new drugs that are, in combination with other drugs, resistance-busters...why none of these at this time?

Lots of questions...anyhow, welcome.

- matt[/font
« Last Edit: October 01, 2007, 03:19:26 AM by newt »
"The object is to be a well patient, not a good patient"

Offline Jeri

  • Member
  • Posts: 4
Re: new regimen ?????
« Reply #2 on: October 01, 2007, 01:08:15 AM »
thanks Newt for info and welcome
I will try to answer questions and post stats,etc. on tomorrow

Offline Jeri

  • Member
  • Posts: 4
Re: new regimen ?????
« Reply #3 on: October 02, 2007, 12:05:44 AM »
 Re new regimen  more info
I am a Black female with lipoathrophy (presently receiving Sculptra tx) thus my over reaction to hint of side effect
my doc feels liquid will work best??? for ME
NRTIs sensitive to   Videx(1.3-2.2)1.30; ZeritXXX; Viread(1.4-4)0.75  Mutations M41L,M184V,L210W,T215Y
NNRTIs sensitive to  Rescriptor(6.2)0.15; Sustiva((3)0.25;  Viramune((4.5)0.40   Mutations none
PIs sensitive to  Prezista/r(10-90)1.16;  Lexiva(2)1.43,Lexiva/r(4-11)1.43; Crixivan&/rXXX;  Kaletra(9-55)2.1;
   Aptivus/r(2-8)1.18; partially sensitive to Invirase/r(2.3-12)7.71   Mutations 1501/L, L63P, A711, G73S, V771,
   L90M
My CD4 is 630    VL is 10,800
Health and stamina is good, I'm very active, low weight is a problem, was dx in 1994 w/ AIDS, CD4 75
I started on AZT but soon went to cocktail, 13 yrs of cocktails
My doc and I believe in the least that will work for now(???); save more potent for later if and when needed
So, why am I complaining, this is the craziest regimen ever just may have to switch liquid

I can see me at security, not to even mention customs with more than 3 ozs, or at the game pulling out a measuring cup     AIDS is no fun!!!!

Offline newt

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  • Posts: 3,887
  • the one and original newt
Re: new regimen ?????
« Reply #4 on: October 02, 2007, 04:15:21 AM »
Hello Jeri

Thanks for the info

Short version:

1. The Sustiva/Kaletra/Viread combo is a very sound choice for your resistance profile, with known management issues eg on side effects.
2. There are several options for refinement/simplification if the logistics/side effects are problematic.

Resistance wise it is a good choice.  You have the classic M184V nuke mutation which makes you resistant to 3TC and FTC. More on this in a moment...

The Kaletra liquid, that's a bugger. Note that it is easy to under dose or over dose a bit here. The new solid form of Kaletra (a tablet not a gel capsule) seems to have less stomach side effects, so this may be a possible simplification.

Sustiva and Kaletra have an interaction, and Sustiva levels can vary genetically, in particular they can be higher in people of African genetic heritage. 

If the Sustiva side effects (if you have them) seem very bad after a while (cos they should settle down), your doc can order a test to look at the level of Sustiva in your blood and adjust the dose if necessary. This test is called Therapeutic Drug Monitoring, and while not routine, can be ordered. It requires a blood draw (more tubes of blood then...).

Sometimes for people who have a lot of experience with treatment the Kaletra dose is increased when combined with Sustiva, but there is no clear recommendation here.

But back to drug choice...

You have a mild PI resistance, and a mild nuke resistance, and I can see that the combo you have solves this.  But it may be too complicated, especially as you have an undetectable viral load. You should be able to keep it that way with either a PI or an NNRTI + 2 nukes....if one of the nukes is 3TC/FTC and the other is Viread, because 3TC/FTC-resistant virus is more susceptible to Viread.

If you wanna stay off 3TC/FTC for possible lipo reasons..

Sustiva + a PI + Viread is the obvious choice (as now). 

If the Sustiva does your head in then Viramune may be an option.  There is a caution over Viramune for women with CD4 counts over 250 because the risk of a bad reaction is higher, but recent studies suggest this probably don't apply to people with suppressed viral loads (like you) as the reaction seems to relate to getting the virus under control (and yours is already).

Virologically speaking this is robust, but the logistics...hmm.

If you are prepared to take 3TC/FTC..

3TC/FTC + Viread + either Sustiva or a boosted PI may work.  << this means you could do Atripla ie 1 tab a day. If a PI, I personally would be going for Prezista cos of the mild PI resistance, but Kaletra is still looking strong, it may be enough. Depends how cautious you feel.

The comment on Viramune applies here also.

Tablets are simpler than liquid.  Plus they don't taste bad. I am not sure the syrup is that much better gut wise than the tabs, especially the new ones << You will know better than me cos you's taking it.

The logistics question is important because this is a medium-long term proposition, not a stop gap combo, and adherence is critical eh? (as ever, as ever...), so possible simplification to a formula that is easy to take is important to think about.

I personally am not a fan of saving the strongest for later.  Best combo now!!! (rah rah rah!) But I appreciate your point of view here, and keeping eg Prezista, other new drugs up your sleeve gives you options I guess.

Hope this helps.

Good luck with the Sculptra Tx

- matt
« Last Edit: October 02, 2007, 04:57:53 AM by newt »
"The object is to be a well patient, not a good patient"

Offline Jeri

  • Member
  • Posts: 4
Re: new regimen ?????
« Reply #5 on: October 03, 2007, 08:22:39 PM »
Newt...Thanks so much for the info and input
I'm trying to work a life around this regimen












Hi Newt


Thanks so much for the info and input, this site has never been more useful, being that things are so complicated

I am trying to work this regimen and work life around this regimen right now


I do know I will have to do Stustiva  HS, it zaps me, come on dreams

Think I'll do the liquid for 6 wks and change, I travel

My doc and I have personal relationship, maybe he's being a little hard on me,thinks I need shock/scare therapy?; I'll address this when I do follow up and d/c liquid

It is is hard to be compliant, especially when you're feeling good, but oops when resistance sets in

I have a problem with with timing; I'm working backward with Stustiva am to pm, 5am to 3am now

How much of a change can I make with timing change, would  like to take Stustiva late at nite, but I'm a night owl and I eat at nite, thinking I can take it at 10p, eat at midnite and sleep, oops, Kaletra at  9 and 9 with food, I feel like Cinderalla at the ball











 


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