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Author Topic: Isentress Opinions  (Read 5006 times)

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Offline tommy246

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Isentress Opinions
« on: December 07, 2009, 07:02:40 AM »
With the DHHS bumping up isentress to preferred first line regimen is says alot about the success of this med only 2 years in use i believe.I know alot of regular posters on here seem to be doing very well on it. Performs at least as well as atripla(sustiva) with lesser almost no side effects. I think this will become more popular than atripla very soon. There are strong rumours that this is soon to become a once a day regimen has anybody any news about this ? 
My second question is if you were doing well on atripla as i seem to be (only 1 month so far) would it in your opinion be foolish to change to issentress when it becomes once a day ,would there be any benefits if i had no side effects and was non detectable already with atripla? Regards tommy.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline ad2san

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Re: Isentress Opinions
« Reply #1 on: December 07, 2009, 11:46:16 AM »
Hi Tommy,

the drug is very new ...

Concerning Isenstress once a day there is a little Spanish study on the subject http://www.hivandhepatitis.com/2009icr/icaac/docs/092209_b.html

There is another going on for treatment naive patient 2x400 vs. 1x800 ... I guess that a good six months is required in order to have some result ...

Once again, the drug is very new ....

Take care
Feb   2009 CD4 358 VL 2000 16%
May  2009 CD4 305 VL 3069  14% <---- Started TVD+ATZ/r
Jul  2009 CD4 512 VL <50   18%
Jul 2010 CD4 418 VL <50 24%                     
Switched to Kivexa (Epzicom) + Norvir + Reyataz (due to sleep problem)
Aug 2010 CD4 606 VL <50 25%
Jul 2011 CD4 494 UD 23%
Switched to Kivexa (Epzicom) + Viramune XR (due to kidney problems)
January 2012 CD4 564 UD 31%
October 2012 CD4 684 UD 29%
January 2013 CD4 594 UD 26%
Switched to Kivexa (Epzicom) + Isentress due to BIG increase GammaGT
Feb 2013 CD4 699 UD 28%
May 2013 CD4 385 UD 28%
July 2013 CD4 CD4 636 UD 25%
Oct 2013 CD4 588 UD 39%
Aug 2014 CD4 639 UD 25%

Offline Miss Philicia

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Re: Isentress Opinions
« Reply #2 on: December 07, 2009, 11:53:00 AM »
Keep in mind when discussing Isentress and thinking that it's only been FDA approved for two years, that patients from clinical trials have been on that med now for much longer, so really it's a decent amount of time to know about most things -- I'd say more like close to four years.
"Iíve slept with enough men to know that Iím not gay"

Offline ad2san

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Re: Isentress Opinions
« Reply #3 on: December 07, 2009, 11:54:45 AM »
Miss P, is this a reason to switch from Atripla ?
Feb   2009 CD4 358 VL 2000 16%
May  2009 CD4 305 VL 3069  14% <---- Started TVD+ATZ/r
Jul  2009 CD4 512 VL <50   18%
Jul 2010 CD4 418 VL <50 24%                     
Switched to Kivexa (Epzicom) + Norvir + Reyataz (due to sleep problem)
Aug 2010 CD4 606 VL <50 25%
Jul 2011 CD4 494 UD 23%
Switched to Kivexa (Epzicom) + Viramune XR (due to kidney problems)
January 2012 CD4 564 UD 31%
October 2012 CD4 684 UD 29%
January 2013 CD4 594 UD 26%
Switched to Kivexa (Epzicom) + Isentress due to BIG increase GammaGT
Feb 2013 CD4 699 UD 28%
May 2013 CD4 385 UD 28%
July 2013 CD4 CD4 636 UD 25%
Oct 2013 CD4 588 UD 39%
Aug 2014 CD4 639 UD 25%

Offline Miss Philicia

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Re: Isentress Opinions
« Reply #4 on: December 07, 2009, 12:09:00 PM »
Miss P, is this a reason to switch from Atripla ?

If I was on Atripla, with a suppressed viral load and no side effects, then no I would see no reason to switch.  That's a bit of a no-brainer.

One thing I've found interesting, though AFAIK the results haven't been made conclusive, that it seems patients that switch to Isentress experience a greater than normal boost to their cd4s.  Now, I know doctors like to say that the goal is viral load suppression, and they are correct, for some patients that begin with lower cd4 it should also be a goal rebuild the immune system.  And also many patients increase cd4 levels and then plateau for years.  It will be interesting to see where more progressive clinicians go with that topic.

Personally I experienced a rather massive, instant boost to my cd4s when I switched and it's also consistently remained at this increased level now for two years.
"Iíve slept with enough men to know that Iím not gay"

Offline Assurbanipal

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Re: Isentress Opinions
« Reply #5 on: December 07, 2009, 12:21:22 PM »
If I was on Atripla, with a suppressed viral load and no side effects, then no I would see no reason to switch.  That's a bit of a no-brainer.

One thing I've found interesting, though AFAIK the results haven't been made conclusive, that it seems patients that switch to Isentress experience a greater than normal boost to their cd4s.  Now, I know doctors like to say that the goal is viral load suppression, and they are correct, for some patients that begin with lower cd4 it should also be a goal rebuild the immune system.  And also many patients increase cd4 levels and then plateau for years.  It will be interesting to see where more progressive clinicians go with that topic.

Personally I experienced a rather massive, instant boost to my cd4s when I switched and it's also consistently remained at this increased level now for two years.

I thought there was a study (but I can't remember where I saw it) that suggested that Isentress accelerated the increase in cd4 counts as a sort of one time step up.  I.e. that, measured over a year or two, the other treatments caught up...

And there was some speculation that the result made sense based on where Isentress applied in the HIV replication cycle (stopping infection of tcells at a point before HIV takes over the cell, rather than stopping replication of virus after HIV has already taken over and basically destroyed the cell)



But back to Tommy's point, if you really have something that works with no side effects why switch?  There's always a risk of side effects on the new medicine, and you can't get more convenient than once a day.

But I'd count increased cholesterol and blood sugars as side effects.  Would you include those Tommy?



edit -- I need to wear glasses to see whether I've actually corrected the typos or just added new ones!!! :-[
« Last Edit: December 07, 2009, 12:23:54 PM by Assurbanipal »
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 tommy246

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Re: Isentress Opinions
« Reply #6 on: December 07, 2009, 12:28:14 PM »
Glad to hear your doing well with this med miss philicia . Correct me if im wrong but issentress tackles hiv in a completely different way to other meds and is the only one in its field at the moment so if its going to give the cd4s a bigger boost thats good for everyone regardless of your numbers . Your correct its 4 years as it was in trials for 2 thats a good amount of time to see any major problems,of which there have been none.
I would definately include blood sugars and cholesterol as side effects
« Last Edit: December 07, 2009, 12:31:32 PM by tommy246 »
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline Miss Philicia

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Re: Isentress Opinions
« Reply #7 on: December 07, 2009, 12:57:32 PM »
Correct me if im wrong but issentress tackles hiv in a completely different way to other meds and is the only one in its field at the moment

Yes, but there's another integrase inhibitor, Elvitegravir, in phase 3 clinical trials.  I also see that there are two others being looked at, including MK-2048 by Merck that inhibits integrase 4 times longer than Isentress.
"Iíve slept with enough men to know that Iím not gay"

Offline Inchlingblue

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Re: Isentress Opinions
« Reply #8 on: December 07, 2009, 01:12:37 PM »
Yes, but there's another integrase inhibitor, Elvitegravir, in phase 3 clinical trials.  I also see that there are two others being looked at, including MK-2048 by Merck that inhibits integrase 4 times longer than Isentress.

The other one is GSK-572 which has performed very impressively in early studies (viral load reductions that were big and happened fast).

LINK:

http://www.aidsmap.com/en/news/7DBF2D20-ECAD-402C-BE5C-321401A49E70.asp

Elvitegravir will likely be part of the once a day Quad pill, to compete with Atripla.

LINK:

http://www.hivandhepatitis.com/recent/2009/012009_c.html

Offline tommy246

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Re: Isentress Opinions
« Reply #9 on: December 08, 2009, 04:02:04 AM »
Wow that gk-572 sounds pretty impressive would that be a mono therapy if approved.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline Inchlingblue

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Re: Isentress Opinions
« Reply #10 on: December 08, 2009, 10:49:32 AM »
Wow that gk-572 sounds pretty impressive would that be a mono therapy if approved.

Monotherapy is just one medication and the only real monotherapies that have worked on some people, not across the board, is boosted PI monotherapy, such as Kaletra, which is lopinavir boosted with ritonavir. And I have read some studies where boosted Reyataz can sometimes work as monotherapy. These are technically two drugs (duotherapy) because the main drug is boosted with ritonavir (Norvir).

I'm hoping they find that Isentress and Reyataz can work as duo therapy, it's being studied and looks like it might work with some patients (i.e. those who are treatment-naive or those who have never failed therapy before and have no Integrase or PI resistance).

I guess you're asking because in the study they used it as monotherapy? I thought that was weird, too, and I asked Dr. Gallant about it:

http://www.hopkins-hivguide.org/q_a/patient/recent_questions/gsk-572_integrase_inhibitor.html?contentInstanceId=494563&siteId=7151
« Last Edit: December 08, 2009, 11:15:38 AM by Inchlingblue »

Offline AboutToStart

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Re: Isentress Opinions
« Reply #11 on: December 08, 2009, 09:51:27 PM »
I agree with tommy : if and when Isentress becomes once a day approved it might be a good idea to switch over to it. True, Atripla works great for me, got me undetectable in just a few weeks with minor side effects lasting only in the first few weeks, BUT - there could be long term side effects with Sustiva (metabolic; mental; cognitive etc) that are hard to measure, plus the hardship of having to take it on empty stomach all the time... If there's something out there just as effective (and maybe even a better CD4 booster once VL is already suppresed) with the lowest possible side effects - why not switch to it?!?
If worse comes to worst - can always go back to Atripla...
« Last Edit: December 08, 2009, 10:12:49 PM by AboutToStart »

Offline carpediem98

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Re: Isentress Opinions
« Reply #12 on: December 14, 2009, 11:00:43 PM »
My doctor and I had a long discussion about risk vs. reward in Isentress+Truvada and, based on the available data, I decided that I was comfortable with once-daily dosing, and he was comfortable prescribing it.  That was six months ago. Now, my doctor has his finger more on the pulse of HIV treatments than a lot of other doctors, so he's often on the cutting edge. But he's very effective and not reckless.

I started the combo, taken once a day with or without lunch, depending on what I happen to be doing between 1 and 2 PM.  Within 3 weeks, I was undetectable.  Last month, my CD4s were back up to 700 (from 400) and the trend is upward.  I have never had a major side effect, aside from 15 minutes of nausea the first two days and the occasional diarrhea if I don't eat lunch before taking it.

If you're comfortable with the cutting edge, I can offer my personal experience as anecdotal evidence of the effectiveness of a once daily combination of Truvada (1 pill) and Isentress (2 pills).  And you almost certainly won't feel drunk, dizzy, "off," or any of the other things that people so often describe as a result of Sustiva (the offending element of Atripla).  It's a matter of what you and your doc are comfortable with!

Either way - good luck!

Offline tommy246

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Re: Isentress Opinions
« Reply #13 on: December 15, 2009, 08:00:43 AM »
Thats very interesting , is this in final trials at the moment for effectiveness of once daily dosing of isentress with truvada anyone know when results are due or how the trial is going.
Once a day dosing is alot better for adherence reasons and thats why i am happy with my atripla at the moment but to be honest i think isentress is a slightly better med , a little better than sustiva regarding cholesterol and trigilcerides , can be taken with or without food and without the dizziness some people get for a few hours after taking it allowing morning dosing.
When once a day i will change as long as doc agrees and as someone else said you can always go back to atripla which is still a great med, but i think there might be some long term health benefits.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline ad2san

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Re: Isentress Opinions
« Reply #14 on: December 15, 2009, 11:21:02 AM »
Hi guys,

i'm getting lost .... how come you can switch back to Atripla? I thought that once you stop a drug mutation start to build up ... this is why it is important to constantly take the medication.

Am I missing something here  ???

Thanks
Feb   2009 CD4 358 VL 2000 16%
May  2009 CD4 305 VL 3069  14% <---- Started TVD+ATZ/r
Jul  2009 CD4 512 VL <50   18%
Jul 2010 CD4 418 VL <50 24%                     
Switched to Kivexa (Epzicom) + Norvir + Reyataz (due to sleep problem)
Aug 2010 CD4 606 VL <50 25%
Jul 2011 CD4 494 UD 23%
Switched to Kivexa (Epzicom) + Viramune XR (due to kidney problems)
January 2012 CD4 564 UD 31%
October 2012 CD4 684 UD 29%
January 2013 CD4 594 UD 26%
Switched to Kivexa (Epzicom) + Isentress due to BIG increase GammaGT
Feb 2013 CD4 699 UD 28%
May 2013 CD4 385 UD 28%
July 2013 CD4 CD4 636 UD 25%
Oct 2013 CD4 588 UD 39%
Aug 2014 CD4 639 UD 25%

Offline Inchlingblue

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Re: Isentress Opinions
« Reply #15 on: December 15, 2009, 11:46:30 AM »
Hi guys,

i'm getting lost .... how come you can switch back to Atripla? I thought that once you stop a drug mutation start to build up ... this is why it is important to constantly take the medication.

Am I missing something here  ???

Thanks

There are different reasons for switching drug combos.

If a person is on a combo and he/she is undetectable and doing well but is experiencing side effects that affect their quality of life then switching to a new combo will not cause resistance to develop. You cannot just stop and not take something else. What you do is switch, you stop one combo one day and start the new combo the next day, without interruption. If you switch this way, then you can always switch back later on if you want, since the switch was made for side effect reasons, not because of resistance.

If a person is failing on a combo, meaning they have a significant viral load despite taking the meds, then this is a sign that there is most likely resistance. In this scenario you must switch because the combo you are on is not working any more and you cannot go back to it later since you already know that it won't work for you.

So there is a difference in switching because of side effects with a combo that is working at controlling HIV and switching because you have no other choice because the combo stopped working, two different things.

If a person needs to stop medications and is not going to immediately switch to a new combo then depending on the meds they are on, there is a proper way to stop in order to minimize the chances of developing resistance. It depends on the half-life of the different drugs, or how long they stay in your system.  This is different from switching. If someone needs to stop Atripla and is not switching to something else, then one has to take just Truvada by itself for a certain number of days so that the levels of Sustiva and Truvada can be as equal as possible in order to avoid resistance (because Sustiva has a longer half-life than Truvada). If you just stop Atripla and don't do this you run the risk of developing resistance since you will have higher levels of Sustiva with lower levels of Truvada and this can cause the virus to mutate and develop resistance.

Offline bufguy

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Re: Isentress Opinions
« Reply #16 on: December 15, 2009, 04:18:44 PM »
I had a discussion with my doctor about isentress the other day. He has been prescribing it for a number of his patients. His one caveat is that isentrees appears to have a much shorter half life than sustiva. Sustiva can stay in the body as long as a week. And although he would never recommend it he knows of patients that take saturdays "off" and have remained undetectable while taking Atripla.
His opinion is that if you are tolerating Atripla it is still the gold standard. Plus there is the once a day dosing.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

Offline Inchlingblue

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Re: Isentress Opinions
« Reply #17 on: December 15, 2009, 06:41:18 PM »
I had a discussion with my doctor about isentress the other day. He has been prescribing it for a number of his patients. His one caveat is that isentrees appears to have a much shorter half life than sustiva.  

Isentress is unlike other HIV drugs when assessing its duration of effectiveness. Instead of its pharmacokinetics, looking at its half-life, scientists are looking at another barometer, its "off-rate," or how long it binds to the integrase enzyme. It appears that it binds for a much longer time than expected, a period that exceeds its half-life. It's the reason that it's being studied for once  a day dosing

One concern with Isentress is it's low barrier to resistance, but Sustiva also has a low barrier to resistance.

LINKS:

http://www.thebody.com/Forums/AIDS/Meds/Current/Q198101.html

http://www.thebody.com/content/art49168.html
« Last Edit: December 15, 2009, 06:57:01 PM by Inchlingblue »

Offline AboutToStart

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Re: Isentress Opinions
« Reply #18 on: December 15, 2009, 11:01:21 PM »
I may switch from Atripla to Isentress even before it gets approved for once a day... True, the once a day dosing is a big + of the Atripla, but for me adherence is not really an issue, and the small burden of taking the pill twice a day is offset by the comfort of not having to be burdened with food restrictions.. for me - is the pill is good and works better as far as side effects ---> why wait??

Offline Miss Philicia

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Re: Isentress Opinions
« Reply #19 on: December 15, 2009, 11:21:14 PM »
I've always thought having no food restrictions would be more important than once a day dosing.  Of course, I still don't have the good fortunes of not having any food restrictions, but it's still nothing like one regimen I had a decade ago that entailed three separate doses each day, two with food (full meal, not snack) and one entirely without (IIRC it meant no food 2 hours before and after the dose).  Try doing all of that and working 9-10 hour days, plus an hour commute, daily gym workout and active social life. 

I guess I just figure if you're having to take pills daily what's the difference between one dose or two?  However having to fuss with timing of meals is a much steeper slope.
"Iíve slept with enough men to know that Iím not gay"

Offline tommy246

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Re: Isentress Opinions
« Reply #20 on: December 16, 2009, 10:34:43 AM »
Thats a good point there no big deal with one dose or two for most people especially as it is saving our lives , the bottom line is there both excellent meds both with plus points . Someone mentioned the sustiva half life as being long , what is the truvada half life .
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline Inchlingblue

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Re: Isentress Opinions
« Reply #21 on: December 16, 2009, 10:47:22 AM »
Thats a good point there no big deal with one dose or two for most people especially as it is saving our lives , the bottom line is there both excellent meds both with plus points . Someone mentioned the sustiva half life as being long , what is the truvada half life .

It's not as long which is why if someone stops taking Atripla altogether they have a good chance of developing resistance. After a few days the Truvada has worn off and all you have in your system is Sustiva so the virus is unevenly challenged and is likely to mutate.

I think Buffaloboy was saying in one of his threads that when he stopped Atripla his doctor prescribed just taking Truvada for several days (I think one week, I'm not sure) in order to avoid resistance.

Of course if one is undetectable and switching meds while on Atripla then one can just stop Atripla one day and start the next combo the next day. The point being to have enough active drugs in your system to keep the virus suppressed at all times.

re: Isentress and no food restrictions, I agree, it's one of the reasons I chose it. It outweighs the twice a day thing, to know I can just take it and not have to worry about eating or not eating. I was traveling recently, staying with friends who don't know about the HIV and I would just slip off into the kitchen and take it without having to call attention to myself by having to eat something.
« Last Edit: December 16, 2009, 10:51:05 AM by Inchlingblue »

Offline buffaloboy

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Re: Isentress Opinions
« Reply #22 on: December 27, 2009, 09:32:58 PM »
I think Buffaloboy was saying in one of his threads that when he stopped Atripla his doctor prescribed just taking Truvada for several days (I think one week, I'm not sure) in order to avoid resistance.

I had to take Truvada for 10 days after stopping Atripla.

Offline beefbud

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Re: Isentress Opinions
« Reply #23 on: December 29, 2009, 02:55:53 AM »
I recently (a little over a month ago) switched from Atripla to Truvada/Isentress due to bad CNS side effects from Sustiva.  Best change I could have made with no visible side effects!  So far labs still show undetectable levels.
Best change I could have made and the twice a day as opposed to once a day is a small price to pay for the hellish side effects I had with Atripla.
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