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Author Topic: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz  (Read 4925 times)

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Offline Okealyshire

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Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« on: January 09, 2010, 01:13:49 AM »
Hey everyone...happy to see the community here is still going strong. Missed reading the threads and participating while I was dealing with some extended job issues...got laid off, fortunately found another great job. Less travel, more personal time, all's good these days.

The insurance plan I'm on now has higher prescription copays, so to save a bit of money I looked for possibilities to get off Norvir so that I can reduce the number of prescriptions from three to two. After studying the December 2009 guidelines, it seems the only other choice for once-daily dosing is Epzicom and Reyataz (I'm resistant to NNRTIs). I chatted with my IDD about switching from Truvada to Epzicom. Many of his other patients are on this regimen and doing well, so I had the HLA-B*5701 test. Got the results today: negative. Yay!

Anyone else on this combo? What do you think of it? I'll place my first order next week.
« Last Edit: January 09, 2010, 01:53:53 AM by Okealyshire »

Offline Inchlingblue

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #1 on: January 09, 2010, 10:25:13 AM »
I have a close friend on it but he started out with a very high vital load so the doctor wanted to include Norvir and has kept him on it for some reason, so he's on Reyataz/Epzicom/Norvir.

He's doing great, went from 700K viral load and about 250 CD4s to undetectable and about 800 CD4s and feels great and looks great. You might want to hear from people on just Reyataz/Epzicom but I figured I'd share his experience just in case.

As far as NNRTI resistance, Intelence apparently works in many cases where there is previous NNRTI resistance.

Keep in mind that Isentress is likely to be approved for once a day dosing in the near future.

Here is a recent article about dropping the Norvir for those on Reyataz/Epzicom/Norvir:

Switch From Norvir-Boosted to Unboosted Reyataz Safe and Effective

http://www.aidsmeds.com/articles/hiv_reyataz_atazanavir_2351_16988.shtml


Offline Okealyshire

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  • Posts: 139
Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #2 on: January 09, 2010, 02:54:14 PM »
I saw that article, which was the motivation for me to do the research about making the switch. I read that Epzicom has moved from "preferred" to "alternate" status because concerns about possible increased heart attack risk; since other studies don't confirm this claim and there's no history in my family of heart attacks, I feel comfortable about making the switch.

When Isentress is approved for once-daily dosing, I might consider another change, this time to Epzicom + Isentress. I think I'd prefer this over Truvada + Isentress because the bone and kidney issues related to tenofovir concern me. Plus, getting off PIs completely has a certain appeal -- I'm 43 and still very twink-like, I'd like to keep the lipids in check! hahaha...

Offline Inchlingblue

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #3 on: January 09, 2010, 03:14:14 PM »
I'm also not convinced about the abacavir and heart attack connection. Below is a good article in case you haven't seen it already.

I'm on Isentress/Truvada, since July 2009 and I'm seriously considering switching the Truvada to Epzicom for the same reasons you mention.

LINK:

http://www.aidsmap.com/en/news/B125FC65-35B6-4347-9394-306E6B1F09F6.asp

Offline ad2san

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #4 on: January 20, 2010, 01:44:56 PM »
hi guys,

i went to my quarterly appointment today. I am may on TVD + Reyataz + Norvir (first therapy). Blood analysis are fine. I had some adaptation problems in the first months of taking the meds but I am doing fine, except that I have terrible problem sleeping, without lunesta I just can't.
My doc searched for the reasons for not falling/staying asleep, including sleep lab, nothing.
So he suggest to switch Truvada with Epzicom/Kixeva.
I am a little bit puzzled. Actually, on HIV side, the combo is working ... I am not found about going for an "adaptation round" again by change the combo ...
Any experience in switching ? Is sleep with Epzicom/Kixeva good (for those who have problems ?)
Cheers
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 Okealyshire

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  • Posts: 139
Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #5 on: January 20, 2010, 02:00:46 PM »
Any experience in switching ? Is sleep with Epzicom/Kixeva good (for those who have problems ?)
Cheers

Tomorrow is my last dose of the Truvada + Reyataz + Norvir combo. Once I start the Epzicom + Reyataz combo, I'll report back my experiences.

Offline Forever England

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #6 on: January 20, 2010, 06:46:16 PM »
Tomorrow is my last dose of the Truvada + Reyataz + Norvir combo. Once I start the Epzicom + Reyataz combo, I'll report back my experiences.

Not wishing to hijack this thread, but I'd be curious to hear how you do too. I switched from Atripla at 23:30 to Truvada+Reyataz+Norvir at 21:00 last week and am finding it hard to fall asleep at night and INCREDIBLY hard to wake up the following morning.

Offline risred1

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  • Posts: 419
  • My Source for Supps - www.newyorkbuyersclub.org
Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #7 on: January 22, 2010, 05:46:02 PM »
Definitely interested in your experiences on this change. I'm considering it as well.

Thanks!! Looking forward to it.

risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

Offline flip408

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #8 on: January 26, 2010, 01:14:12 AM »
I was on trial with reyataz norvir and either truvada or epzicom.   Turns out I am on epzicom, so I am thinking I could stop the norvir and continue with reyataz and epzicom.?

Just had my highest CD4 430 and 16 %, and vl <50 from 11/2006.   My providers say "if it ain't broke don't fix it"  and yea I have never had a single side effect from this my first combo. 

What if ADAP crumbles, reyataz and epzicom are cheaper.  Are there long term effects from Norvir I could avoid?

 

 
Start where you are, use what you have, do what you can.    A Ashe
05/14/11  501  <50  20%
4/14/11  483  <50  19%
2/10/11    523  <50 18% start Rilpivr/trvda
11/15/10  470  <50
1/6/10    430  <50  16%
7/13/09  345  <50  12%
1/26/09  347  <50  16%
7/22/08  306  <50  6%
11/26/07 238 <50  8%
6/11/07  253  <50  5%
11/9/06  122  <50 7%
9/05/06  <25 >100000  PCP

Offline Okealyshire

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  • Posts: 139
Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #9 on: January 27, 2010, 01:30:54 PM »
So I've been on the new combo for seven days. A few observations...

I haven't noticed any changes in sleep patterns; I've always been a light sleeper, though, and it isn't uncommon for me to wake up during the night. Occasionally I'll take a 1 mg alprazolam (Xanax) when I sense that I'm not going to sleep well.

My, uh, gas production has reduced, which is certainly a good thing! No additional symptoms have appeared. When you drop the Norvir from this combo, you have to increase the Reyataz dose from 300 mg to 400 mg (two 200 mg capsules). I haven't noticed any increase in yellowing.

Probably the most curious thing is the cost differential. Using drugstore.com as an example, here are prices without insurance for 90 days:

Truvada, 90 tablets -- $2975.34
Reyataz 300 mg, 90 capsules -- $2962.78
Norvir 100 mg, 90 capsules -- $839.98
------------------------
Total -- $6778.10

Epzicom, 90 tablets -- $2660.29
Reyataz 200 mg, 180 capsules -- $2952.54
----------------------
Total: $5612.83

I really don't understand how increasing the daily dose of Reyataz from 300 mg to 400 mg ends up costing a few dollars less! Even more curious is how my insurance company prices them. Truvada is a preferred drug, Epzicom isn't. So my co-pay for the Epzicom is a bit higher. Since my co-pay for the Reyataz didn't change, dropping the Norvir from the regimen results in a lower total co-pay. But still, overall my insurance company is saving a whole lot (*) after I made this change, I wish my savings were greater.

(*) The conspiracy theorist in me wonders if my insurer gets a kickback from Gilead but not from GlaxoSmithKline? Hmm...

Offline risred1

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #10 on: January 29, 2010, 08:06:13 PM »
any of the classic symptoms?

headache, fatigue, digestive, rash, fogginess?
risred1 - hiv +
02/07 CD4 404 - 27% - VL 15k
10/07 CD4 484 - 31% - VL 45k
05/08 CD4 414 - 26% - VL 70k
01/09 CD4 365 - 23% - VL 65k
05/09 CD4 291 - 23% - VL 115k - Started Meds - Reyataz/Truvada
06/09 CD4 394 - ?% - VL 1200 - Boosted Reyataz with Norvir and Truvada
07/09 CD4 441 - ?% - VL 118 - Boosted Reyataz with Norvir and Truvada
09/09 CD4 375 - ?% - VL Undetectable - Boosted Reyataz with Norvir and Truvada
12/09 CD4 595 - ?% - VL Undetectable - VIT D 34 - Reyataz/Truvada/Norvir

Offline Okealyshire

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  • Posts: 139
Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #11 on: January 30, 2010, 12:32:45 AM »
headache, fatigue, digestive, rash, fogginess?

Nope, none at all. Very happy with the change, though I know it's been only a week so far.

Offline Okealyshire

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #12 on: February 04, 2010, 02:56:54 AM »
Second week on Epzicom + Reyataz combo. Absolutely no symptoms at all, I'm very pleased with the outcome. Still supplementing with vitamin D + calcium because the research doesn't appear conclusive about whether bone loss is specifically because of Tenofovir in Truvada or a more generalized HIV response.

Looking forward to forthcoming research on Epzicom + once-daily unboosted Prezista. If there are good results from that, I'd consider another switch -- mainly to avoid the food and H2 limitations with Reyataz; fortunately it appears I'm not afflicted with jaundice.

Offline Inchlingblue

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Re: Switching from Truvada + Reyataz + Norvir to Epzicom + Reyataz
« Reply #13 on: February 04, 2010, 09:59:57 AM »
Second week on Epzicom + Reyataz combo. Absolutely no symptoms at all, I'm very pleased with the outcome. Still supplementing with vitamin D + calcium because the research doesn't appear conclusive about whether bone loss is specifically because of Tenofovir in Truvada or a more generalized HIV response.

According to Dr. Gallant "mild loss of bone density occurs initially with all ART regimens but is not progressive." This is good to know although it's still unclear based on that statement if tenofovir causes even more of it.

LINK:

http://www.hopkins-hivguide.org/q_a/patient/antiretroviral_therapy/antiretroviral_agents/nucleoside_and_nucleotide_reverse_transcriptase_inhibit/isentress___epzicom_.html?contentInstanceId=512496

 


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