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Author Topic: Starting Treatment  (Read 2299 times)

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Offline tnbigd

  • Member
  • Posts: 9
Starting Treatment
« on: February 11, 2009, 05:52:09 PM »
I have been poz since June, 2005, and within the next couple of weeks I am to start meds.  I know I can't take Atripila, because of resistance to NNTRI's.  Not exactly sure what the means, but I guess I will find out tomorrow. 
I want to go into this meeting somewhat informed, but the amount of information out there is mind numbing.  I also realize that every case is different; but can anyone offer any advice regarding the various types of meds and what has the least amount of side affects?

Thanks,
T
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

Offline newt

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  • Posts: 3,878
  • the one and original newt
Re: Starting Treatment
« Reply #1 on: February 11, 2009, 06:35:17 PM »
Hello, a big but hopefully productive step for you health

The typical first-line therapy uses a drug, in combination with other drugs, called efavirenz. This is an NNRTI. (non-nucleoside reverse transcriptase inhibitor) NNRTI resistance usually means you can't use any standard  NNRTIS. Atripla includes efavirenz.

The alternative is a PI (protease inhibitor). There are many to choose from. The best bet in terms of side effects is one which is used with the smallest dose of Norvir (ritonavir). Norvir is a booster drug that makes PIs effective at lower doses, and therefore reduces side effects. 100mg of Norvir is the lowest standard booster dose, and this tends to mean less side effects, eg gut effects, raised blood fats. Some PIS require 200mg. Two that use 100mg are Reyataz (atazanavir) and Prezista (darunavir). Kaletra, an older, but effective drug, uses 200mg of Norvir as a boost.

If Norvir or the PIs don't agree it is likely docs will reach for an integrase inhibitor eg Isentress. This don't need boosting.

Regardless, all these drugs are effective.

The PI or integrase inhibitor needs combining with two other drugs. Usually this is tenofovir + FTC (Truvada) or abacavir + 3TC (Kivexa, Epzicom). Both work. Truvada is perhaps currently more popular.

Non-nucleoside reverse transcriptase, protease and integrase are all enzymes needed by HIV to reproduce. The drugs block them from working, hence inhibitor in their description.

You will find details of each drug under the drugs section of this website.

The i-Base guide "Introduction to combination therapy" may also help (even though it's a UK guide the principles are the same).

With the drugs mentioned above I wouldn't personally expect many serious/more than short term side effects. You will never know till you take the damn things, and some people will have a bad reaction to individual drugs, but overall these are considered relatively kind. None of the drugs I have noted are connected in a big way to fat loss or body shape changes, for example.

Hope this helps.

Let us know how it goes.

- matt


Edited for crap spelling
« Last Edit: February 11, 2009, 07:03:09 PM by newt »
"The object is to be a well patient, not a good patient"

Offline tnbigd

  • Member
  • Posts: 9
Re: Starting Treatment
« Reply #2 on: February 11, 2009, 07:01:00 PM »
Hi Matt,
Thanks for the insight!  The names of all the various drugs alone is maddening enough ???, not  to mention how they all interact.  This will definitely be helpful!

Again, thanks!
T
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

Offline Inchlingblue

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  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Starting Treatment
« Reply #3 on: February 11, 2009, 07:47:12 PM »
tnbigd:

Truvada with Rayataz/Norvir is a good combo. and so is Truvada with Isentress. Issentress has only been FDA approved for treatment-experienced patients but its is being studied on treatment-naive patients such as yourself and the preliminary results are excellent. I have read on thebody.com that it is expected to be approved for treatment-naive patients later this year and doctors are able to prescribe it in the meantime if they want to. Below is a link of a study in which Isentress went head-to-head with Sustiva and did very well:

http://www.aidsmeds.com/articles/1667_12618.shtml

Offline Inchlingblue

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  • Chad Ochocinco PETA Ad
Re: Starting Treatment
« Reply #4 on: February 11, 2009, 07:53:26 PM »
I forgot to mention, above, that they each have pluses and minuses as far as dosing. Reyataz should be taken with food, preferably a complete nutritious meal. It is once a day dosing so that it good. If you go with Isentress there are no indications as far as food, you could have it with or without food but the dosing is twice a day. They are looking to do a formulation that  would be once a day but that is not yet available.


Offline tnbigd

  • Member
  • Posts: 9
Re: Starting Treatment
« Reply #5 on: February 11, 2009, 10:10:07 PM »
Great information.  Thank you very much.  All this info. you all have provided will help me in my appointment tomorrow.

T
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

Offline tnbigd

  • Member
  • Posts: 9
Re: Starting Treatment
« Reply #6 on: February 12, 2009, 08:38:53 PM »
Here is what I found out today.  My doctor is recommending either Epzicom/Reyataz/Norvir or Truvada/Isentress.  I have looked at both and can't really see a difference except three pills versus two pills.  Anyone have any thoughts?  I also read that NTRI's can cause body fat changes; has anyone had big issues with this.  I work in a rather conservative job, and that part is really freaking me out.

Thanks,
T
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

Offline aztecan

  • Member
  • Posts: 5,394
  • 29 years positive, 57 years a pain in the butt
Re: Starting Treatment
« Reply #7 on: February 12, 2009, 09:03:21 PM »
Hey Y,

Neither of the two nukes your doctor is recommending include a high likelihood of body shape changes, i.e., lipoatrophy.

It is possible, but much less likely than some of the older nukes. Of those recommended, the only one I've taken was Epivir, which is a part of Epzicom.

Reyataz/Norvir is a dandy combo. I liked it when I took it because it was once a day dosing and caused me no side effects. Unfortunately, I have GERD, so I have to take antacids and other stomach meds, so I had to switch.

I have had no experience with Isentress either. The only down side I can see to it is it must be taken twice a day.

How do you feel about once versus twice a day dosing?

HUGS,

Mark

"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline BM

  • Member
  • Posts: 340
Re: Starting Treatment
« Reply #8 on: February 12, 2009, 09:27:13 PM »
I'm currently taking both Isentress and Reyataz/Norvir. My nuke is Viread (one of the drugs in Truvada). My previous regimen included Epzicom.

Some people have an allergic reaction to one of the drugs in Epzicom (Abacavir) and you should be screened in advance for susceptibility to this. Reyataz can cause a waste product called bilirubin to rise in your blood (this is harmless, but in some cases it can make you appear a bit jaundiced). As Mark pointed out, if you experience any sort of stomach acid upset, you'll have to change drugs as antacids and other treatments can stop Reyataz working properly.

The Viread component of Truvada can cause a loss of bone mineral density in the first six months, but this is not thought to cause serious problems. It is also potentially associated with kidney problems. Isentress is the first in a new class of drugs which has a lot of people excited as it seems to cause very few side effects in people beyond a bit of a headache at the beginning. It is also very good at bringing down viral load quickly.

Despite the potential drawbacks of HIV drugs, most people experience no problems with them, and the combinations your doctor has suggested are some of the best with regards side-effects. It's your choice!

Offline Inchlingblue

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  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Starting Treatment
« Reply #9 on: February 12, 2009, 09:38:22 PM »
I wonder why he is not also recommending Truvada/Reyataz/Norvir? In terms of Epzicom, it is not recommended for anyone with a high viral load (100,000+) so I assume your viral load is under that if he is recommending it.

Offline tnbigd

  • Member
  • Posts: 9
Re: Starting Treatment
« Reply #10 on: February 12, 2009, 09:46:13 PM »
Thanks All!  I really appreciate you sharing your experiences and thoughts.  This is a whole new experience for me, and it justs seems so daunting.  I really only have a few friends who are poz and only one is on meds, so I haven't had many people to talk to.  I need to have my labs done once more before I start to find out what the latest numbers are before I start on the meds.  I also have to have the resistance test to Epzicom. 

I currently pay for my cobra which isn't great.  I have a job interview next week, so hopefully I will get better benefits.

Again, thanks,
T
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

Offline Inchlingblue

  • Member
  • Posts: 3,119
  • Chad Ochocinco PETA Ad
Re: Starting Treatment
« Reply #11 on: February 12, 2009, 10:25:42 PM »
The new economic stimulus bill will have a provision to help people pay for COBRA....make sure you continue the COBRA, it's important to have uninterrupted coverage.....if by any chance COBRA were to run out, you could get what they call a HIPAA policy, but you obviously don't need to worry about that right now...just mentioning it so you know that there are options.....

Offline tnbigd

  • Member
  • Posts: 9
Re: Starting Treatment
« Reply #12 on: February 12, 2009, 10:43:46 PM »
Thanks for the update.  I have about 10 months left on the Cobra, but hopefully I won't need it much longer. 
06/22/05 Diagnosed
06/22/05 CD4: 448 (29%) VL: 177,000
09/27/08 CD4: 435 (30%) VL: 678,000
01/18/06 CD4: 409 (28%) VL: 160,000
05/14/06 CD4: 428 (52%) VL: 750,000
08/22/08 CD4: 468 (28%) VL: 175,020
11/17/08 CD4: 357 (22%) VL:   99,000
05/29/09 CD4: 285           VL: 300,000
06/06/09 Starting Truvada and Kaletra

 


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