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Author Topic: The right way to do treatment interuption  (Read 3651 times)

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Offline Customer

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The right way to do treatment interuption
« on: August 14, 2006, 04:14:25 PM »
The smaller the virus population is during the interruption, the smaller is the chance the virus will be able to mutate to resistant generation.--> planned treatment interruptions should be done at undetectable VL to minimize the risk of resistance.

The virus will be able to generate a resistant generation most probably against the medicine which remains the longest time in the body after the interruption and runs practically as solo-drug for some time.
--> the least important medicine should be interrupted last
--> idea of sacrificial drug (add Fuzeon to your regimen before interruption, quit the 3-med combo, and halt use of Fuzeon last. if resistance arises, it will be against Fuzeon, not your primary meds)

With known half-lifes the pattern of medicine decay in the body can be calculated.--> The medice with shortest half-life should be interrupted last. The medicine with longest half-life should be interrupted first, in order to accomplish rapid simultaneous medicine decay


Long periods of time at undetectable levels can cause the immune system to forget HIV. Forgetting implies poor response after treatment interruption and an acute infection syndrome after interruption.--> IR103 or similar could be used for a couple of month before interruption to keep immune system aware of virus.


http://www.aidsmeds.com/news/20060803clin002.html


« Last Edit: August 14, 2006, 05:12:57 PM by Customer »

Offline Cliff

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Re: The right way to do treatment interuption
« Reply #1 on: August 15, 2006, 07:16:40 AM »
The virus will be able to generate a resistant generation most probably against the medicine which remains the longest time in the body after the interruption and runs practically as solo-drug for some time.
--> the least important medicine should be interrupted last
--> idea of sacrificial drug (add Fuzeon to your regimen before interruption, quit the 3-med combo, and halt use of Fuzeon last. if resistance arises, it will be against Fuzeon, not your primary meds)
That doesn't sound like a good idea to me.  Just because you're not on Fuzeon (or whatever drug), doesn't mean that the drug is not important to you.  As you develop resistance you will need different classes/meds available for treatment. 

Is the risk of developing resistance, when you stop at undetectable, significant enough to worry about adding a 4th drug?  I didn't think so.

Offline Jacques

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Re: The right way to do treatment interuption
« Reply #2 on: August 15, 2006, 10:46:18 PM »
I aggree sith you Cliff. 

Fore sure, reading this, I refer to stay on meds.

Jacques
Jacques
Living positively since 1987
latest lab :july 2010
Undetectable Cd4 1080
43% on Reyataz/Norvir/Truvada

Offline foster2006

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Re: The right way to do treatment interuption
« Reply #3 on: August 16, 2006, 05:08:49 AM »
From what I was told by my Doctors and Nurses is to stop all meds at same time.

I had to do so, early on due to Combivir severe side effects -- Anemia which required a 4 day hospital stay. 
Once the Anemia was cleared up and not a problem about, 2 weeks after leaving hospital, I was allowed to start back on the meds, but combivir was replaced by Truvada. Combivir was the NRTI backbone that pfizer picked but has option of Truvada if Combivir causes a problem.
Nurse Practioner prescribed Truvada, and the HIV/AIDS Study Nurse gave me the other pills I have to take.

11/21/2006 CD4        VL <50
10/02/2006 CD4 1034 VL 114
09/06/2006 CD4 1595 VL   87
08/02/2006 CD4 1266 VL <50
06/07/2006 CD4 1412 VL <50

Diagnosed 10/18/2004
Truvada(1x day) & Maraviroc (2x day)

Offline Customer

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Re: The right way to do treatment interuption
« Reply #4 on: August 16, 2006, 11:26:51 AM »
Foster2006. Do you know the half-life of each component in your cocktail?


Offline Customer

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Re: The right way to do treatment interuption
« Reply #5 on: September 05, 2007, 04:08:06 PM »

For instance, Bristol-Myers Squibb has adopted the philosophy of "rapid, and simultaneous decay" in their product instructions for Sustiva

http://www.aidsmeds.com/archive/Sustiva_1615.shtml

In turn, if you plan to stop a drug regimen that contains Sustiva and do not plan on immediately switching to a new regimen, it is best to stop the Sustiva first, several days before you stop the other anti-HIV drugs (for example, the Combivir). You should plan this out, with your healthcare provider, before stopping your drug regimen.

Most importantly, if you plan to make a treatment stop you should be "undetectable". That is the most important rule. Probability of resistant mutation is directly proportional to viral load, so be sure to be as low as possible upon treatment stop.





Online Miss Philicia

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Re: The right way to do treatment interuption
« Reply #6 on: September 05, 2007, 04:12:49 PM »
The idea of sacrificing Fuzeon really, REALLY seem unwise to me.  While I realize that many of you are "OMGNEEDLES!" and think you'll never go on it, it's one of the most potent HIV meds out there and you should think twice about making your body resistant to it.

I think it's the LAST HIV med I'd choose to do this to.

Care to say why you chose to say this, Customer?
"Iíve slept with enough men to know that Iím not gay"

Offline thunter34

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Re: The right way to do treatment interuption
« Reply #7 on: September 05, 2007, 04:26:43 PM »
There sure has been an awful lot of talk around here lately about treatment interruptions- from people planning drug holidays or unusual "few months on and a few months off"  to people deciding not to even take a regimen properly from the outset in some sort of bargaining / balancing arrangment with their virus and the meds. 

i'm not really on the same page with all this- based solely on my own personal experience and nothing else.  because for me, these icky pills made me impossibly sick for a great long while at the beginning.  once adjusted, i am generally on a cruise mode with them.  i don't wanna chance losing any options and i don't wanna risk getting sick all over again from an acute infection syndrome or a reajustment period to the meds.  i'm gonna try to ride this partiucular train as long as it will roll. 

i'm well aware that the meds can lead to some pretty awful health occurences on their own, but i don't see them as being any worse than the inevitable bout with PCP or CMV or MAC or XYZPDQ that can and will come about eventually in their absence. 

and if you're gonna try for a sacrificial drug (for whatever reason you're even thinking about dong that), couldn't you pick an older, more crappy drug to sacrifice?  i sure as hell wouldn't sacrifice fuzeon- and i despise needles.  (besides, honey- they have bioject dealies for fuzeon now that don't require needles.) 

i recognize that for some individuals the side effects of some of these meds are truly daunting, but unless i was facing such adversity from them i would stay on them. 
AIDS isn't for sissies.

Online Miss Philicia

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Re: The right way to do treatment interuption
« Reply #8 on: September 05, 2007, 04:31:58 PM »
Hello hun... I'm the Biojector Queen!  I've never had to touch one of those atrocious needles, and yes I was one of the OMGNEEDLES crowd :)

I agree with Missy Hunter on the "icky pill" meme.  While I have at times had some bad med experiences, I've had worse experiences with the actual HIV virus.  Nuf said there for me. 

Other than some diarrhea sessions I've not had a bad pill experience now for the past six years.  I think that's a pretty OK record actually... this ain't the 90's that's for sure.
"Iíve slept with enough men to know that Iím not gay"

Offline Customer

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Re: The right way to do treatment interuption
« Reply #9 on: September 05, 2007, 04:34:14 PM »
Dear philly267.

actually, the point was not Fuzeon. The point was the the idea of sacraficial drug. And even that was a minor point of my writing.
I mentioned fuzeon because i read it maintains reduced efficiency   agaist those virus-strains who are resistant to it. So even if you get Fuzeon resistance, you keep on getting virological benefit from using it. That means, Fuzeon resistant HIV-strains have lower replication rate than wild strain HIV.  However, the sacraficial drug could be some old and not-preferred anti-HIV drug.

Offline thunter34

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Re: The right way to do treatment interuption
« Reply #10 on: September 05, 2007, 04:46:06 PM »
How interesting.  I just noticed this thread is actually a year old.


Customer, what exactly is your intent with this thread? 
AIDS isn't for sissies.

Offline Ann

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Re: The right way to do treatment interuption
« Reply #11 on: September 05, 2007, 04:56:49 PM »
Customer, what meds are you on and are you thinking of taking a treatment interruption?

Ann
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Online Miss Philicia

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Re: The right way to do treatment interuption
« Reply #12 on: September 05, 2007, 04:58:28 PM »
How interesting.  I just noticed this thread is actually a year old.


Customer, what exactly is your intent with this thread? 

Oh wow, I didn't notice that year lapse either.

So Customer -- are you yourself doing a treatment interruption?  It's hard to tell where you are at with your HIV diagnosis and history with HAART from you past posts.  In fact, I can't even tell for sure if you've ever been on meds, and can only make the assumption that you've even been diagnosed as positive.  Just curious.
"Iíve slept with enough men to know that Iím not gay"

Offline Customer

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Re: The right way to do treatment interuption
« Reply #13 on: September 05, 2007, 05:11:57 PM »
Yes i am poz since 2006. Never on meds though.

Offline thunter34

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Re: The right way to do treatment interuption
« Reply #14 on: September 05, 2007, 05:15:32 PM »
Yes i am poz since 2006. Never on meds though.


so what exactly prompted you to start this thread?
AIDS isn't for sissies.

Offline aztecan

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  • 29 years positive, 57 years a pain in the butt
Re: The right way to do treatment interuption
« Reply #15 on: September 05, 2007, 11:03:01 PM »
I am confused as to why anyone would even consider "sacrificing" a med?

Exactly what is the point of doing that? If someone is going to do a STI, or whatever it is they're calling it these days, then coordinate it with your doc.

But to add a drug just to sacrifice it seems both wasteful and inane.

What would be the benefit?

HUGS,

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

Offline Customer

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Re: The right way to do treatment interuption
« Reply #16 on: September 07, 2007, 02:36:23 PM »

I do not encourage anyone to take treatment interruption without sufficient consideration and professional consultation.

Treatment interruption is suitable for

a) people with medicine complications and who are planning a long drug holiday
b) people who lack financing of haart
b) people who started haart very early during ARS and are therefore candidates for excellent virus controllers

In my opinion, treatment interruptions should always extend to long periods of time (> 6 months), and have a target viral set-point in untreated environment, and have a pre-defined return to haart limit, require monitoring, etc...

The depletion rate of your immune system is (pretty much) directly proportional to your viral load, and therefore it is necessary to keep viral load down, a goal which in most cases can only be accomplished with haart.




Offline thunter34

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Re: The right way to do treatment interuption
« Reply #17 on: September 07, 2007, 02:59:07 PM »
I have zero interest in taking any sort of drug holiday, but I do have a question:

If you go off these drugs for an extended period of time, don't you end up getting sick all over again from having to adjust to them once more?  I got the ick just from a few days / a week or so off of them.  I surely would not consider taking an interruption unless I was facing some pretty grave consequences from them.

I still don't get the sacrificial drug bit.
AIDS isn't for sissies.

Offline Customer

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Re: The right way to do treatment interuption
« Reply #18 on: September 07, 2007, 03:10:47 PM »
If the meds work fine for you, and you have got the cash, then i suggest you stay on meds. I think all you guys staying on meds are doing the right thing. (These are my amateur wanna-be medics comments)


PS.
In some post someone was concerned about missing a dose.. it is related to this thread...  namely

missing a dose on high viral load poses much greater risk of resistancy than missing a dose at undetectable VL. I do not suggest you start forgetting doses when undectable, but you can use this information in you risk assesment.

 


Offline leatherman

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Re: The right way to do treatment interuption
« Reply #19 on: September 07, 2007, 04:40:58 PM »
If you go off these drugs for an extended period of time, don't you end up getting sick all over again from having to adjust to them once more?  I got the ick just from a few days / a week or so off of them.  I surely would not consider taking an interruption unless I was facing some pretty grave consequences from them.
My answer is yes, you can possibly get sick, and then have side effects all over again from restarting the meds. Of course, your results may vary, but for me it always led to serious consequences.

My chart in my sig line shows where I went off meds and back on. Basically, the side effects were, to me, personally worse than dying, so I would just stop treatment. Within 9 months, I would have the high VL all over again and be sick as a dog. (As soon as I got thrush each time, I knew I had been off meds too, too long :o)

Then not only would have I to suffer adjusting to the side effects all over again, but I would have developed resistance to some of the meds and have to start new ones - with MORE side effects, and still sick from the sky high viral load and low tcells.

Getting a better doctor, and getting past the depression from losing my partner and being so sick myself, I've finally gotten to a place where I realize that off my meds means serious sickness leading to death. So you won't see me doing that again. I've learned my lesson.  ;) It only took a couple of trips to the hospital. ::)


leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

 


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