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Author Topic: Reyataz truvada combo without Norivir  (Read 4448 times)

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Offline inmontreal

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Reyataz truvada combo without Norivir
« on: April 05, 2009, 07:49:38 PM »
for the past year i switched from Kaletra and Truvada (my cd4s went from 240 to about 440 in one year) to Reyataz, Truvada and Norivir (from 440 to now 977). I explained to my doc that I get really tired and light headed and sometimes feel like my brain short circuts due to being wiped out. So he suggested I take out Norvir and increase the Reyataz.
I tried to find in past postings to see if anyone went through this also and are good without Norvir but couldnt find any link to really answer my question..Is it safe and possible to get high cd4 without the norivir?

Offline BM

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Re: Reyataz truvada combo without Norivir
« Reply #1 on: April 05, 2009, 08:01:01 PM »
All the literature I've read warns against using Reyataz without the Norvir boost because the Viread component of Truvada significantly reduces blood levels of Reyataz, which in turn increases the risk of Reyataz resistance.

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #2 on: April 05, 2009, 08:15:54 PM »
Thanks for replying...I just dont get it..my doc is a veteran HIV specialist, so why would he tell me to stop taking Norivir? I wonder if anyone else is on the unboosted version and have been doing good for years. So far i just have to do it for a week and then follow up with a blood test to see it isnt dropping my cd4s.

Offline Assurbanipal

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Re: Reyataz truvada combo without Norivir
« Reply #3 on: April 05, 2009, 08:31:47 PM »
You might find the Reyataz page on this site helpful for more info (it repeats the warning against Truvada and unboosted Reyataz and has some more discussion)
http://www.aidsmeds.com/archive/Reyataz_1563.shtml
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Ann

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Re: Reyataz truvada combo without Norivir
« Reply #4 on: April 06, 2009, 06:02:53 AM »
Hi Montreal,

This is interesting for me because the Reyataz/Norvir/Truvada combo is my choice for first line treatment, but the possible side effects of Norvir worry me a little (mainly the diarrhea - I have enough problems with that to begin with).

The standard Reyataz/Norvir dose is 300mg/100mg. You say that your doctor increased the Reyataz, but you don't say what your new dose is - would you please tell us? 

One of the possible side-effects listed here in the Reyataz lesson is this:

Quote
Changes in the way your heart beats may occur when taking Reyataz. If you get dizzy or lightheaded these could be symptoms of a heart problem.

You say your doctor had you quit the Norvir because of your lightheadedness. This leads me to wonder if your doctor thought the Reyataz-boosting property of the Norvir was causing your problem (more Reyataz=increase of Reyataz-related side-effect) or if he thought the Norvir itself was causing the lightheadedness. If he thought it was the Norvir-caused increase of Reyataz doing it, then why didn't he just change the whole Reyataz/Norvir component of your combo?

I think if it were my doctor advocating this approach, my questions for him would be - Do you think the Norvir itself was causing my lightheadedness, or do you think it was the increase levels of Reyataz? If you think it was the increased levels of Reyataz, why did you increase my Reyataz instead of changing the Reyataz/Norvir portion of the combo completely? Do you have any other patients on this version of the regimen, or am I your first guinea pig? Have there been studies done on this approach? Are you planning on doing a study on this approach?

Have you asked your doc any of these questions? If you have, what were his answers? 

I'm very interested in hearing more info from you, particularly what, exactly, did he think was causing your problems, what your new Reyataz dose is, and if your doctor has other patients on this altered Reyataz/Truvada regimen. Thank you in advance!

Ann
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"...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 inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #5 on: April 06, 2009, 08:42:10 AM »
Well according to my doc and pharmacist at the hospital, they both assured me that it has been done with a few others who couldnt take the Norvir and had success. I asked the same questions as you are asking me now.

Before when i was on Kaletra i had the worst time. My mind was always in a fog and i was always wiped out. Then after switching to Reyataz, it was a huge difference but i still use to get these weird mind freeszes (light headiness fog) and use to feel physically wiped out. Sometimes i would wonder if maybe it was something like my hearing or maybe i wasnt getting enough sleep or even if maybe there was something thats wrong with me thats not showing up in my blood labs and has nothing to do with the meds at all..But i guess we wont know until i take a chance and try this out for a week. I just hope doing this "experiment" wont ruin my chances to going back to Norvir.

As of now im taking 2 300mg Reyataz with 1 Truveda. Last night was my first doze and i have to say i did wake up alot easier BUT i still later on had those weird episodes..

Offline Ann

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Re: Reyataz truvada combo without Norivir
« Reply #6 on: April 06, 2009, 09:08:49 AM »
Hi Montreal, thanks for replyiing so quickly.

So your Reyataz dose has been doubled. Interesting. I thought it might have been increased by 50% or so.

So if you're still having the "episodes", maybe you should speak to your doc asap and ask him to have your heart checked out, in light of the possible side-effect I mentioned above. That would suck if it's affecting your heart, but it would be best to know one way or the other.

Heart problems won't necessarily show up in your blood labs - you'd need to be hooked up to a heart monitor. They sometimes give people little strap-on (not that sort! hehehe...) heart monitors that you wear for 24 hours or so to get a picture of what's going on when you have the episodes. (because sod's law, they won't happen when you're in the doctor's office on a monitor)

Please let us know how you get on with this new dosage, and whether or not you decide to talk to your doc about the heart side-effect, and what happens if you do. Good luck! I'm looking forward to hearing more.

Ann
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"...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 Tim Horn

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Re: Reyataz truvada combo without Norivir
« Reply #7 on: April 06, 2009, 10:00:06 AM »
inmontreal:

While there's certainly very little -- if any -- bona fide clinical trial data to support this, the fact that you've questioned your "veteran HIV specialist" and the hospital pharmacist is good. While there are structured treatment guidelines in place regarding dosing and instructions when combining specific drugs, the fact is that antiretroviral therapy can be individualized to meet certain needs. 

That said, a couple things to keep in mind:

1) Without the Norvir boosting, it's probably best for you to STRICTLY adhere to the dosing schedule. In other words, do your best to take your meds every 24 hours, like clockwork. Not only does Norvir boost the maximum blood level of Reyataz, it also prolongs the time therapeutic concentrations of Reyataz remain in the blood. And by dropping the Norvir, you'll possibly be losing the dosing "grace period" that comes with it.

2) Talk with your doc about therapeutic drug monitoring (TDM). Fortunately, testing blood levels of protease inhibitors is fairly easy -- provided that you're able to find a lab that conducts antiretroviral TDM (your doc should know of a lab in Canada offering this). Provided that you have drug-sensitive virus and don't require higher-than-usual concentrations of Reyataz to keep drug-resistant virus in check, the minimum concentration of Reyataz in your blood should be 150 ng/mL.

After you've started the 600 mg Reyataz dose, you may want to check your drug level a few times to make sure it's above this concentration. However, you should know that the 150 ng/mL is the required "trough" concentration -- which is the lowest amount of Reyataz in your blood, usually in the hour or so leading up to your next dose of the drug. If your Reyataz trough concentration is below 150 ng/mL, there's simply not enough of the drug in your body to keep viral replication in check, potentially resulting in the emergency of Reyataz-resistant HIV strains -- not good.

Just some food for thought,

Tim Horn   
« Last Edit: April 06, 2009, 10:03:38 AM by Tim Horn »

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #8 on: April 06, 2009, 10:16:20 AM »
Thanks for taking the time to write as well as showing concern guys..
Well Tim..i guess i was hoping someone would step forward and say they too are on the same regiment and doing good but i guess so far im the only one..Scared like hell but again we wont know till we try right?
And if things dont work out i will go back on Norivir and hope to God it will take me back..lol
But i think what Ann suggested might be a good idea as well..to wear the heart monitor just to see if there is something there..In any case i will keep you guys posted on here to let you know if i turn yellow, pass out or drop dead..lol...kidding..

Offline Miss Philicia

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Re: Reyataz truvada combo without Norivir
« Reply #9 on: April 06, 2009, 12:06:20 PM »
You could also look into enrolling in the GS-9350 clinical trial -- it's a replacement booster for Norvir by Gilead.
"Iíve slept with enough men to know that Iím not gay"

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #10 on: April 07, 2009, 10:55:10 PM »
Well its tuesday night..a friend on here told me about another site where you write in and an HIV specialist replies back with an answer.. Here is the link:

http://www.hopkins-hivguide.org/q_a/patient/recent_questions/reyataz_without_norivir.html?contentInstanceId=476205&siteId=7151

He pretty much said the same things you guys were thinking and tomorrow morning i will call the clinic where there is a pharmacy department (who are aware that im doing this) and let them know i will go back to my old dose with Norivir. The only reason why i see my doc doing this would be just to see if i was sensitive to the Norivir. Andif for some reason i was feeling better, he would either replace the whole thing or find a substitute for the Norivir.. I'll keep you posted on the saga ;)

Offline anniebc

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Re: Reyataz truvada combo without Norivir
« Reply #11 on: April 08, 2009, 02:09:05 AM »
Hi Montreal

I'm on Reyataz, Emtriva and Viread (we don't have Truvada here yet) I came off the Norvir a little over a year ago, with the blessing of my ID Doc, and apart from abnormal cholesterol levels i have had no problems whatsoever..my VL is undetectable and CD 4 is sitting at 880, in the year I have been off the norvir I had a detectable level a few months ago and that turned out to be a blip/

I'm on 2x200mg of Reyataz.

Everyone is different i know but I'm doing really well without the Norvir.

Hugs
Jan
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Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #12 on: April 15, 2009, 08:38:29 AM »
well its been a little over a week that I have been off Norivir. And what a difference! I feel wide awake. I don't feel exhausted or dizzy no matter how much or little sleep I get. I did my blood work yesterday so hopefully it will show good results. If not there has to be a regiment that is available that wont distort my body or have bad  side effects like the runs, body morphing or feeling wiped out. If anyone is on a good one let me know. If the reyataz with truveda is not enough I should think of a back up that does not contain Norivir.

Offline John2038

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Re: Reyataz truvada combo without Norivir
« Reply #13 on: April 15, 2009, 12:52:24 PM »
It happen sometime that the ID doc decide to increase/decrease the dosage of a drug, for e.g. because the patient is experimented, got low immunity, etc..

For e.g., in the case of the "combo" Reyataz + Telzir + Norvir, usually prescribed for patient with CD4 below 200 with resistances to some NRTIs/NNRTIs typically, the dosage can be either

ATZ 300mg + FPV/r (700mg/100mg)
ATZ 400mg + FPV/r (1400mg/100mg)

or a mix of both dosage, once or twice a day.

In this particular exemple, the dosage might be increased not only due to the fact that the FPV can reduce the concentration of the ATZ is the blood (by typically 20%),  but also due to the fact that the patient is experimented.

If I am talking about this combo it's because the symptoms you are experiencing (ATZ+FPV/r have a very good CSF penetration (but others also, such as AZT, DLV, NVP, etc), which can be helpful), its relationship with the dosage, the use of Norvir or not, and aslo because others have already discuss about your combo.

Symptoms

HIV-associated cognitive impairment may be attribuable to a low immunity (and may improve with use of HAART),  but no matter the immunity level, it continues (sometime at a good level like yours) to be a major clinical problem among individuals with advanced infection.

Toxoplamose and others infections can also contribute to cognitive impairment, but it is much more common when the CD4 are low (under 200).

Some combos can lower the symptoms

So sometime, in such case, switching to a combo with a very good CSF penetration may help to lower the problem (despite that the CSF penetration is not the only criteria if we take the example of the Sustiva).

Booster

About the booster, to be noted that a study have found a comparable potency between of the FPV boosted with 100mg and the FPV bossted with 200mg of Norvir, as well as a better adherence to their medications for the patient treated with 100mg of Norvir.

In more, ATZ+FPV/r is also sometime prescribed without Norvir.
See this study


Sorry if I am not talking directly about your combo, but I was just willing to illustrate the fact that in some case, the dosage/frequency can be increased, Norvir be used or not, etc.


In more, FPV+ATZ is sometime use to try reduce neurocognitive impairements, and I thought it could be interesting for you to know that.

Of course, I am only giving a 1 cent opinion and no more.
Only your ID Doc can advise you. Me I am just offering a grain of salt.

John


Note 1

You might be interested to read these articles.
ref1, ref2

Note 2

Of course, the uses of combo above implies no major resistances to it among others things.
It is also not a true 3-drugs regimen, but the adjunction of a 3rd potent drugs is depending of the host.
« Last Edit: April 15, 2009, 02:11:59 PM by John2038 »

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #14 on: April 16, 2009, 12:44:39 PM »
Hey John, thanks for taking the time to respond with some valuable reading. I understand what you mean and I really hope my doc is doing what is right and will work for me. At this point im nervous because I am worried that the Truvada is going to decrease the Reyataz and will eventually lower my cd4 and put an increase in my VL. Not to mention im scared shitless that because of not using Norivir, that somehow the virus will get around the Reyataz making me immune to it.. I guess we have to wait and see the results..But what then? Do i go back on Norivir only to feel exhausted everyday? or change meds? And which ones would be the most tolerable without the side effects. I got through Kaletra combo then the Reyataz combo..If i can't handle those two easy ones, whats left?

Offline BlueMoon

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Re: Reyataz truvada combo without Norivir
« Reply #15 on: April 16, 2009, 12:55:59 PM »
Quote
I got through Kaletra combo then the Reyataz combo..If i can't handle those two easy ones, whats left?

Isentress?

I have been on Truvada/Reyataz/Norvir for over a year now.  They have been kind to me, but last month I added Isentress due to an inability to get my viral load undetectable.  If things work out I hope I can drop the Reyataz/Norvir.  There are several members here on Truvada/Isentress, and they all seem to be doing well. 
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #16 on: April 16, 2009, 04:19:57 PM »
thanks Blue Moon..I will really look into that..im glad there is a site for people to talk with..sure helps ALOT!

Offline newt

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Re: Reyataz truvada combo without Norivir
« Reply #17 on: April 16, 2009, 06:38:27 PM »
I think you need not fret.

Provided adherence is good, 400mg Reyataz with Truvada will work for a large proportion of people, esp. with viral load <50.

If your viral load looks like it's rising you can either add the Norvir back in or go for a new drug, and this need not compromise the success of your treatment.

I wouldn't worry about viral breakthrough and illness, just keep a close eye on your viral load and take action if it becomes necessary (ie viral load jumps over 150 on 2 consecutive tests).

XX

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

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #18 on: April 17, 2009, 12:00:11 AM »
again it really helps to have people send you messages and say all the things you need to hear which is why im thankful for finding this site. I think alot of times when you are left alone with your thoughts, you find yourself in a dark place and start panicking. I know i have alot to educate myself in, but again I thank you for the insight. And you are right, as long as I am undectable, i shouldnt worry so much and just let whatever happens, happen and deal with things as they come.
Thank YOU!

Offline John2038

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Re: Reyataz truvada combo without Norivir
« Reply #19 on: April 17, 2009, 01:48:27 PM »
inmontreal

you might be interested by this study.

10th Int PK Wrkshp: How Much (or How Little) Ritonavir Do You Need to Boost Another PI?

Protease inhibitors (PIs) fall into two groups--those whose concentration correlates closely with the boosting dose of ritonavir, and those that do not--according to a 16-study systematic analysis by Andrew Hill (University of Liverpool) and colleagues at other centers [1]. Finding the lowest effective boosting dose could cut costs and lower the risk of side effects. Hill suggested 50 mg of ritonavir once daily--or less--may be enough to boost some PIs.
 
Hill analyzed results of 16 PI/ritonavir dose-ranging studies.


More

I guess that if you want more opinions on your available options, you may want to post your resistance profile (genotype). All of them if you made more than one.

Keep Well,
John

Offline inmontreal

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Re: Reyataz truvada combo without Norivir
« Reply #20 on: April 20, 2009, 10:34:21 AM »
Well I got my lab results back...So far its been about 3 weeks on without Norivir. Still undectable which is good but the cd4s dropped from 977 to 570 in about month's time. Liver enzymes were normal along with everything else.. I have to go in again for more blood work next week to see if there will be any more changes..Im really happy about the labs but the cd4 is starting to get me nervous. The nurse assured me that there usually is a change in CD4s or Liver enzymes when changing or going on meds.. I guess we'll see..

Offline Ann

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Re: Reyataz truvada combo without Norivir
« Reply #21 on: April 20, 2009, 11:57:01 AM »
Hi In,

Any idea what your CD4% was? Chances are that it didn't change very much between the two draws. The percent tends to be a more stable number.

Stress can also help lower your absolute CD4 count - and I would imagine you've been stressed lately, worrying about this combo change. Try to relax about it a bit and see if your CD4s dont' rebound. CD4s fluctuate from hour to hour, so try not to sweat it too much.

Ann
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"...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

 


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