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Author Topic: Which regimen ???  (Read 2231 times)

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Offline John2038

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Which regimen ???
« on: October 17, 2007, 11:45:10 AM »
Hi,

I decided to start an early treatment. Among the reasons I have, few articles I have read (some listed below) and the fact this this approach seems to be more and more (studies) the best option:

http://www.i-base.info/htb/v8/htb8-8-9/HIV.html
http://www.aidsportugal.com/article.php?sid=7603
http://www3.niaid.nih.gov/news/NIA [...] entHIV.htm
http://forums.poz.com/index.php?topic=16211.0

Daily on the internet, we can found new clinical studies trying to determine the best regimen in regard of various factors such as the impact on the  counts, the side effects, toxicity, dosage, etc.

Examples of such articles: http://www.natap.org/hiv.htm

Its become then almost impossible to make a choice on which regimen to choose.
In more, my doctor is not following daily such studies and so if I listen to his advices, they will probably be outdated.
I'm still staying with this doctor because in the country where I am working now there is no real hiv specialist with cutting edge skills.

So I'm looking for some directions.
I'd like get an idea of what could be the best available treatment available today, accordingly to my profile.
I will then read about them, and take a decision that I will discuss with my doctor.

So could you be please be so kind to provide me your best advices knowing that I'm:

1 ) man 40 years old
2 ) a bit overweighted, but should be fine in 2-3 months
3 ) smoker (but plan to stop before the end of the year)
4 ) not under any medication
5 ) Haven't get any particular disease all along my life
6 ) Good shape, no visible effect of the hiv on me now
7 ) CD4 = 509 VL = 1732   CD4% = 18.7 CD4 Seltelling = 509 / uL (Sept. 07)
8 ) Otherwise, all parameters in the biochemie report are within the standard ranges, in the exception of:

PARAMETER                RESULT                  High/Low      Standard Range
Chloride                         108 mmol/L            H                 98-107
Alkalies phosphate    49 IU/L                   L                 53-128
Neutrocyte                       26% 1.32x10^9/L    L                  2-7.5

9 ) Contaminated probably around Q2 07. Seroconversion probably around July 07


Many thanks !
« Last Edit: October 17, 2007, 03:33:56 PM by John2038 »

Offline ronaldinho

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Re: Which regimen ???
« Reply #1 on: October 17, 2007, 12:54:19 PM »
should not this question be posted in the "Questions about treatments" forum?

Offline newt

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Re: Which regimen ???
« Reply #2 on: October 17, 2007, 01:10:50 PM »
Other baseline investigations that may be helpful relate to cardiovascular health: cholesterol, glucose metabolism and perhaps C-reactive protein.

Baseline investigations relating to meds should be: a resistance test, kidney function and liver function.

CV health is important long-term and some meds can raise lipids which increases CV risk.  Therefore this information may be useful in meds selection. If all is within normal range, well and good. Resistance test, kidney function and liver function provide information to inform med choice, resistance because that determines which meds will work, kidney and live because particular meds can affect these adversely/are contraindicated for people with kidney/liver disease.

Other than that, provided you have no resistance, a textbook standard combination of 2 nukes plus either 1 non-nuke or 1 boosted PI will do the trick (couple of unboosted options on PIs, but studies indicate these generally not as durable). There's lots of choice.

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

Offline John2038

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Re: Which regimen ???
« Reply #3 on: October 17, 2007, 03:41:06 PM »
Many thanks newt.
I have put in my to do list the test you recommend:

cholesterol
glucose metabolism
C-reactive protein
resistance test
kidney function
liver function


About the HIV type, I have read that there are 2 kind of HIV (1/2) and multiples groups.
IMHO, I believe that such infos are very important (regimen).
However, in all my reading, including the posts in this forum, nobody is really referring to its  HIV type and group.

Any reasons ?




Offline newt

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Re: Which regimen ???
« Reply #4 on: October 17, 2007, 04:58:44 PM »
Indeed there are two basic genotypical strains - HIV serotype 1 and HIV serotype 2.  Each has a selection of clades or subtypes. The common virus in the USA is HIV type 1 clade B. It is usual to find out which one you have when you are diagnosed. Since treatment was developed for HIV 1, reading results for effectiveness etc generally means for HIV 1. However, HIV 2 is treatable. Clades/subtypes not so important in terms of outcomes.

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

Offline risred1

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Re: Which regimen ???
« Reply #5 on: October 17, 2007, 08:54:51 PM »
You do need a full blood workup for all those components with Liver Function, hormones levels (thyroid and testosterone), etc.

The resistance test is also critical in determining treatment options.

Because the options are so many, it is a long discussion with my specialist at every appointment to determine what is in favor today.

Because of you body chemistry, current health and possible viral resistance and the HIV genotype you have, there can't be an assumption of what is best for you without considering all these components and a review of what your lifestyle may require.

My doctor loves Atripla because the Sustiva is considered a "gold" standard for anti viral performance. For his practice, adherence is critically important, and his patience who can tolerate Sustiva find it easier to take a single drug once a day.

But he noted with me since I currently take 38 supplement pills a day in two doses, that adherence may not be a defining issue for me. I also have some liver sensitivity and digestive issues that I have under control, but it is a factor to consider in treatment. We are actually leaning toward Reyataz and Epzicom, or Reyataz, Truvada, Norvir. I personally like option one as if I don't need to take Norvir, i would prefer it. The treatment profile of Reyataz and Epzicom looks pretty good for me.

But things are changing fast. With the approval of Integrase inhibitors, it may change front line treatment again. If i can wait until they are approved for front line treatment, i may very well have a different combo in mind.

Not just last year, he was talking PI based, Sustiva Based, and PI based as the first three combo moves. The idea was that one might be able to go from 6 to 18 years on these three combos alone. Now that we have fusion and integrase inhibitors available, and maturation inhibitors on the way, and New PI's, Nukes and Non Nukes, there may be more choices and harder and harder decisions on what direction to go in. I hate to say it is a good problem to have, because a problem with treatment may turn into a highly variable puzzle, difficult to determine best efficacy with lowest side effects for any cycle of treatment. But I'm not going to complain about having options. We just have to do lots of homework and help our specialists figure out what plan will work for us individually.
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 John2038

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Re: Which regimen ???
« Reply #6 on: November 09, 2007, 05:28:53 PM »
Hi,

I will definitely start very soon (next week) taking drugs, taking into accounts your points.

In more, do you know if there is a website containing up-to-date recommendations about the best regimen, taking into account the latest clinical tests ?

Many thanks

John

Offline John2038

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Re: Which regimen ???
« Reply #7 on: November 09, 2007, 06:45:33 PM »

 


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