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Author Topic: Switching meds with a detectable viral load??  (Read 2379 times)

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Offline markaj

  • Member
  • Posts: 80
Switching meds with a detectable viral load??
« on: August 27, 2008, 01:59:34 PM »
I've been on Kaletra and Truvada for 2 months and have reached my limit with Kaletra. The last straw was anal fissures after continuously passing abnormal stools - the pain was unbearable and nitroglycerin and salts to soften stools was too little too late, this was all after the nonstop diarrhea and popping loperamide all day. I just seemed to go from one extreme to another.  I've told my clinic I want to swap Kaletra to Sustiva. They're not happy and want me to wait until I go undetectable. I really can't wait until then. Is it really such a big deal to switch now? My viral load tumbled anyway - last bloods were taken 2 weeks into treatment - figures below.  It's left that I've got to go in Friday, repeat bloods and then see my doctor straight after. I take that to mean they're going to let me switch. I just hope they're not going to make me wait 2 weeks for the results of those bloods first. I realise Sustiva is a whole new ball game with it's own issues, I just think I might be able to manage those better than Kaletra's. I'd really appreciate getting lots of advice about this. Cheers.
Infected Jan 08 / diagnosed Feb 08
Feb 08 - CD4 230 (9%) VL 3.5 million
Mar 08 - CD4 440 (6%) VL 660.000
Apr 08 - CD4 420 (11%) VL 3 million
Jun 08 - CD4 200 (7%) VL 3 million
Started Kaletra/Truvada Jul 08
Jul 08  - CD4 250 (14%) VL 23.893
Aug 08 - CD4 410 (15%)  VL 4.313
Switched to Sustiva/Truvada Aug 08
Switched to Reyataz/Norvir/Truvada Sep 08
Diagnosed with Hep C, HIV meds stopped for a bit
Nov 08 - CD4 414 (12%) VL 500.000+
Started Isentress/Truvada Nov 2008
Dec 08 - CD4 381 (17%) VL 1.116
Jan 09 - CD4 534 (20%) VL <50
Started Interferon/Ribavirin Jan 09
Feb 09 - CD4 407 (24%) VL <50
Mar 09 - CD4 360 (28%) VL <50
Apr 09 - CD4 279 (30%) VL <50
Jun 09 - CD4 298 (36%) VL <50
Aug 09 - CD4 303 (35%) VL <50

Offline atlq

  • Member
  • Posts: 518
Re: Switching meds with a detectable viral load??
« Reply #1 on: August 27, 2008, 02:17:36 PM »
Mark,

I'll give ya a few thoughts, but I don't know if they will add up to an opinion:

I was on Kaletra for two years with Truvada, so I know the issues you are dealing with. Although the gastrointestinal stuff gets better after a few months (at least for me) it never goes away. Truvada adds to the fun with its flatulence inducing powers...


It is best, whenever possible, to switch meds when you are undetectable to insure that there are fewer resistance issues and to increase the probability that you will stay undetectable....

Did you have a baseline genotype done to show if you have any med resistance? If you have and you don't then I think asking for a switch under the circumstances you describe is reasonable.....(hey, that is an opinion!)...

Even though its causing you problems, it looks as if the Kaletra/Truvada combo is working for you...You should be undetectable soon....Congratulations on the great VL drop!......


P.S.That's my two cents, but there are plenty of folks here far wiser than I when it comes to treatment issues, so more counsel should be rolling in soon!....
« Last Edit: August 28, 2008, 09:36:41 AM by atlq »
“Keep up the good work....   And God bless you.”
  --  Sarah Palin, to members of the Alaskan Independence Party, 2008

Offline markaj

  • Member
  • Posts: 80
Re: Switching meds with a detectable viral load??
« Reply #2 on: August 27, 2008, 02:37:31 PM »
Thanks atlq.  My clinic did the resistance test when I was first diagnosed and at that time my virus wasn't resistant to anything thank goodness, although to be honest sometimes my 2nd dose of Kaletra in the evening isn't always at exactly the same time and where i've been stressing about wanting to switch meds it's been a real struggle taking them at all.  Yesterday I deliberately took them an hour late and nearly didn't take them at all.  I know that's really stupid but this whole illness has completely taken over my life and I can't seem to move on from it.  I just want to be able to pop some pills and get back to the way things were before and these current side effects are dominating my life.  All respect to you.  Thanks.
Infected Jan 08 / diagnosed Feb 08
Feb 08 - CD4 230 (9%) VL 3.5 million
Mar 08 - CD4 440 (6%) VL 660.000
Apr 08 - CD4 420 (11%) VL 3 million
Jun 08 - CD4 200 (7%) VL 3 million
Started Kaletra/Truvada Jul 08
Jul 08  - CD4 250 (14%) VL 23.893
Aug 08 - CD4 410 (15%)  VL 4.313
Switched to Sustiva/Truvada Aug 08
Switched to Reyataz/Norvir/Truvada Sep 08
Diagnosed with Hep C, HIV meds stopped for a bit
Nov 08 - CD4 414 (12%) VL 500.000+
Started Isentress/Truvada Nov 2008
Dec 08 - CD4 381 (17%) VL 1.116
Jan 09 - CD4 534 (20%) VL <50
Started Interferon/Ribavirin Jan 09
Feb 09 - CD4 407 (24%) VL <50
Mar 09 - CD4 360 (28%) VL <50
Apr 09 - CD4 279 (30%) VL <50
Jun 09 - CD4 298 (36%) VL <50
Aug 09 - CD4 303 (35%) VL <50

Offline atlq

  • Member
  • Posts: 518
Re: Switching meds with a detectable viral load??
« Reply #3 on: August 27, 2008, 02:45:03 PM »
Yesterday I deliberately took them an hour late and nearly didn't take them at all.  I know that's really stupid but this whole illness has completely taken over my life and I can't seem to move on from it.  I just want to be able to pop some pills and get back to the way things were before and these current side effects are dominating my life.  All respect to you.  Thanks.

You have every right to feel the way you do about side effects and to demand other options if you need to change your regimen......but until you make that switch, please stay adherent to your meds...you are going to be dealing with this for a lifetime (a long lifetime) and the development of med resistance is a complication you don't want to have to deal with (and it is something you can control). Kaletra is one of the more powerful ARV's with a long half life, so an hour here or there doesn't matter, but don't let an hour late turn into a day off....The side effects do get  better and there are a number of treatment options with minimal side effects...Hang in there, it does get (much) better!.... :)
“Keep up the good work....   And God bless you.”
  --  Sarah Palin, to members of the Alaskan Independence Party, 2008

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: Switching meds with a detectable viral load??
« Reply #4 on: August 27, 2008, 03:23:38 PM »
Hello

Your current peripheral blood viral load is well within the grasp of Sustiva's virus bombing powers (even if the VL is a bit higher in other parts of your body). Waiting will not improve the chance of success.

Me, I'd be having a resistance test now, just to be belt and braces (even while switching without delay).

As for "back to normal" -- this is achievable, sooner than you think perhaps, but like learning to drive, gotta give it full attention and priority before highway cruising becomes a one-handed affair.

Treatment will save your life and let you get on with realising your hopes, dreams etc. It's worth a little time.

I sincerely hope the Sustiva is kind to you and this is not out of the frying pan and into the fire.

Good luck

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

Offline Roie

  • Member
  • Posts: 263
Re: Switching meds with a detectable viral load??
« Reply #5 on: August 28, 2008, 12:47:40 AM »
I have been on the kaletra truvada combo for 6 months. My stomache ailments i deal with by mixing half a teaspoon of ground Indian cinnamon into my coffee.  I take it 4 times a day.
It has helped remarkably with diahreah, and  works almost immediately.

My doctor perscribed Sustiva, but it turned out that i am resistant to it so he gave me Kaletra.
my VL became undetectable  with in the first month and my CD 4 went up from 270 to 414. I take 2 Kaletra pills in the morning and then 2 in the evening with the Truvada.


 
Cruise on down the High Way

"When people who are not ready jump in, things can go horribly wrong. For most of us, there is always time to take a deep breath, consider one's options and make a careful, sound decision based on clinical fact, not emotion."
MtD

Offline Miss Philicia

  • Member
  • Posts: 24,426
  • celebrity poster, faker & poser
Re: Switching meds with a detectable viral load??
« Reply #6 on: August 28, 2008, 07:41:13 AM »
What's wrong with switching to Reyataz instead?
"I’ve slept with enough men to know that I’m not gay"

Offline Grasshopper

  • Member
  • Posts: 454
Re: Switching meds with a detectable viral load??
« Reply #7 on: August 28, 2008, 08:25:51 AM »
When I started taking AZT in the fall of '92 , I had no choice but to swallow those damned pills and put up with the side effects. This went on with others meds until '96 when my docters realized that the meds would be killing me sooner than OI's would due to Aids, so I stopped taking them.
I re-started HAART in the summer of 2001, and have changed combo's several times but with Kaletra always being the main component.
My body always needed some time to adjust to the new regiment. And I've learned to be patient. I remember with the "old" formula of Kaletra I had bouts of bowel irregularities, but never severe.
I'm now on Kaletra & Truvada for roughly a year and a half, and find this to be the friendliest combo ever. I take all five pills at once with my morning coffee at 6 am., and am done for the day with the hiv dance.
I can only nitpick about the Truvada, and that is the bloathing and flatulance it tends to cause. Limiting my intake of dairy products or chewing some "Simethicone" tablets takes care of the discomfort.

I would humbly suggest you give your body a chance to adjust, afterall 2 months is a relatively short time. HAART is not innocent, and you're bound to encounter some sort of side effects sooner or later.

Like Matt wrote earlier, every time you switch there is a risk of "falling out of the pan into the fire".

greetz
Grasshopper
« Last Edit: August 28, 2008, 08:27:32 AM by Grasshopper »

Offline markaj

  • Member
  • Posts: 80
Re: Switching meds with a detectable viral load??
« Reply #8 on: August 28, 2008, 01:13:59 PM »
Thanks everybody i really appreciate all the great advice.

'I sincerely hope the Sustiva is kind to you and this is not out of the frying pan and into the fire.'

Matt you pretty much summed up my worst fears in a nutshell - not hacking Sustiva and going back to my clinic with my tail between my legs begging for a 3rd combo. 

Roie if I stick with Kaletra I'll try your good suggestion, cheers, that's once I stop taking Movicol salts to give me loose stools!  I am happy with diarrhea at the moment with these fissures and goodness knows what else, less painful!

Philly267, good point about Reyataz, I'm not sure if it's licensed as first line treatment here in the UK though, I will ask tomorrow.

Grasshopper, much respect for your honesty my friend. 2 months isn't long I realise that and compared to the side effects of the past, which I can only imagine, my experiences have been fairly tame for sure.

I don't know what to do!  But you've all given me lots to think about.  Thanks again.
Infected Jan 08 / diagnosed Feb 08
Feb 08 - CD4 230 (9%) VL 3.5 million
Mar 08 - CD4 440 (6%) VL 660.000
Apr 08 - CD4 420 (11%) VL 3 million
Jun 08 - CD4 200 (7%) VL 3 million
Started Kaletra/Truvada Jul 08
Jul 08  - CD4 250 (14%) VL 23.893
Aug 08 - CD4 410 (15%)  VL 4.313
Switched to Sustiva/Truvada Aug 08
Switched to Reyataz/Norvir/Truvada Sep 08
Diagnosed with Hep C, HIV meds stopped for a bit
Nov 08 - CD4 414 (12%) VL 500.000+
Started Isentress/Truvada Nov 2008
Dec 08 - CD4 381 (17%) VL 1.116
Jan 09 - CD4 534 (20%) VL <50
Started Interferon/Ribavirin Jan 09
Feb 09 - CD4 407 (24%) VL <50
Mar 09 - CD4 360 (28%) VL <50
Apr 09 - CD4 279 (30%) VL <50
Jun 09 - CD4 298 (36%) VL <50
Aug 09 - CD4 303 (35%) VL <50

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: Switching meds with a detectable viral load??
« Reply #9 on: August 28, 2008, 01:23:00 PM »
on the bum cracks, give it 6 months << I know from personal experience how painful this is...The secret is soft stools, ie loads of veg << this may not be compatible with Kaletra

Reyataz is licensed for 1st line therapy in the UK now (as of April 2008) and in NHS terms is cost neutral compared to Kaletra. Since Sustiva is cheaper expect to be assertive. In London clinics Reyataz is v v popular so not really an issue to ask for it.

I kept a graph when I started meds, time of each dose, side effects  etc, now my biggest problem is remembering the damn things. I am more concerned now about finishing my decorating than HIV.

3rd, 4th combo, so what? The NHS is there to serve. Get it right, get it sorted, get on with life, sod the doctor's budget problems or view on your interface with clinic.

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

Offline markaj

  • Member
  • Posts: 80
Re: Switching meds with a detectable viral load??
« Reply #10 on: August 29, 2008, 01:09:53 AM »
Cheers Matt...'bum cracks' you made me smile!  Great description.Well it's less than 4 hours until my appointment. Here goes....
Infected Jan 08 / diagnosed Feb 08
Feb 08 - CD4 230 (9%) VL 3.5 million
Mar 08 - CD4 440 (6%) VL 660.000
Apr 08 - CD4 420 (11%) VL 3 million
Jun 08 - CD4 200 (7%) VL 3 million
Started Kaletra/Truvada Jul 08
Jul 08  - CD4 250 (14%) VL 23.893
Aug 08 - CD4 410 (15%)  VL 4.313
Switched to Sustiva/Truvada Aug 08
Switched to Reyataz/Norvir/Truvada Sep 08
Diagnosed with Hep C, HIV meds stopped for a bit
Nov 08 - CD4 414 (12%) VL 500.000+
Started Isentress/Truvada Nov 2008
Dec 08 - CD4 381 (17%) VL 1.116
Jan 09 - CD4 534 (20%) VL <50
Started Interferon/Ribavirin Jan 09
Feb 09 - CD4 407 (24%) VL <50
Mar 09 - CD4 360 (28%) VL <50
Apr 09 - CD4 279 (30%) VL <50
Jun 09 - CD4 298 (36%) VL <50
Aug 09 - CD4 303 (35%) VL <50

 


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