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Author Topic: Isentress/Reyataz/Norvir - Nervous  (Read 6171 times)

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Offline Maggie

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Isentress/Reyataz/Norvir - Nervous
« on: January 14, 2010, 02:00:59 PM »
I just got back from the doctor.  tcells have dropped to the low 300's and viral load 4K.

I have the Isentress/Reyataz/Norvir coming in the mail from ADAP. 

I used to be on Truvada and Viramune which I had no side effects and did great only for it to ruin my kidneys.  I cannot take the Atripla due to severe depression/anxiety.

Has anyone taken this regimen?  I am really scared.

Offline Forever England

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #1 on: January 14, 2010, 02:18:15 PM »
I just got back from the doctor.  tcells have dropped to the low 300's and viral load 4K.

I have the Isentress/Reyataz/Norvir coming in the mail from ADAP. 

I used to be on Truvada and Viramune which I had no side effects and did great only for it to ruin my kidneys.  I cannot take the Atripla due to severe depression/anxiety.

Has anyone taken this regimen?  I am really scared.

I understand your fear. So scary is the prospect of these powerful drugs that the worst case scenario is always the one that's uppermost. For what it's worth - I have no experience with Isentress - the posts I've read suggest it is one of the best tolerated HIV drugs to date. I'm switching to Reyataz+Norvir with Truvada this evening, from Atripla, in the hope that I'll overcome CNS effects. I am no expert and we're all different, but typically Reyataz+Norvir seems well tolerated too - hopefully both of our adjustments will be minimal

Good luck :)

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #2 on: January 14, 2010, 02:45:41 PM »
thank you forever England....  would you please keep me posted on how you do on the Reyataz and Norvir?

Thank you. 

I hope someone else has experience with these.

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #3 on: January 14, 2010, 02:51:35 PM »
The most I felt when I started Isentress was a mild headache, which disappeared with a simple aspirin.  Nothing more, and even at that it was not a daily headache, more like a couple of times each week for the first month. 

I've been on about 17 different HIV meds in my life and Isentress was by far the most tolerable.
"Iíve slept with enough men to know that Iím not gay"

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #4 on: January 14, 2010, 03:08:35 PM »
thank you Miss.  The ones that I am more scared of are the Reyataz and Norvir. 

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #5 on: January 14, 2010, 03:26:18 PM »
From what I have read, the Norvir does not have to be refrigerated if used within 30 days and stored like in the kitchen cabinet?  Just so it doesn't get too warm, correct?

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #6 on: January 14, 2010, 03:39:23 PM »
From what I have read, the Norvir does not have to be refrigerated if used within 30 days and stored like in the kitchen cabinet?  Just so it doesn't get too warm, correct?

Correct.  If you're ordering 3 months supplies just keep the excess 2 months worth in the fridge, and then you can put the current month's supply wherever you keep your other stuff.  It's not a big deal.  Norvir might give you a small amount of diarrhea at first, but the dose is considered a booster and hence is small, so for most people it doesn't annoy.

Reyataz can cause some yellowing in the skin and/or eyes during the first 10 days or so but then it goes away. If people notice it and you've not disclosed your status to them, then just make up some fib about temporary elevated bilirubin levels and that your doctor said it would go away.  Women can easily say it's related to having their period, I think.  Only 10% of people even get this though, so chances are good that you may experience nothing.
"Iíve slept with enough men to know that Iím not gay"

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #7 on: January 14, 2010, 03:45:40 PM »
Thank you again Miss.

Have you ever been on Norvir or Reyataz? 

(( hugs ))

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #8 on: January 14, 2010, 05:01:21 PM »
Thank you again Miss.

Have you ever been on Norvir or Reyataz? 

(( hugs ))

I'm currently on Norvir and have been on it since 2006.  Reyataz I've not ever been on, but know a lot of people who are on it.  Seriously, it's really nothing to be nervous about.  Your doctor has done you good by picking out what should be a very tolerable regimen.  I know you've had all those problems with Truvada, and indeed they do suck, but try not to let that experience color your thoughts leading into this new stuff. I know that's easier said than done, but I hope my comments will allow you some peace of mind.  Best of luck.

David
"Iíve slept with enough men to know that Iím not gay"

Offline risred1

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #9 on: January 14, 2010, 05:03:01 PM »
I'm on reyataz truvada norvir....

Reyataz has been easy for me as well as the truvada.... the norvir is considered low dose, so while I'm not "thrilled" with it, it not that significant.

The reason for the Norvir is to boost the Reyataz in your blood by slowing how fast the liver process's it. Now when you take tenofvanir (sorry for the spelling) which is in Truvada or Atripla or Viread, that drug actually speeds the breakdown of the PI, so you have to boost it.

But Reyataz can be taking in a higher dose with Epzicom with being boosted, although most doctors like to boost the PI regardless. Especially when your VL is detectable. Once your undetectable, I'm sensing some "flexibility" about the use of Norvir.

Now I don't know if with Isentress its is required to boost, perhaps your doctor is just playing it safe.

I wrote a daily log of my transition onto this combo which might help you prepare....

http://forums.poz.com/index.php?topic=27269.0

Reyataz is considered to be as durable as kaletra without some of the side effect profile of that PI. Which was considered at one time the "gold" standard of PI Anti Virals. But with the effectiveness of Reyataz on par with Kaletra, those, like me, who preferred a PI regimine over Atripla, got a good combo with generally better side effect profile than Kaletra.

« Last Edit: January 14, 2010, 05:05:58 PM by risred1 »
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 Ann

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #10 on: January 15, 2010, 03:40:40 AM »
Maggie, are you aware that you are technically on a two drug regimen? The reyataz/norvir element only counts as one drug and isentress is one drug. If I were you, I'd be talking to my doctor about adding another drug from another class, even if you're resistant to that drug, just to be safe.

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 Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #11 on: January 15, 2010, 07:34:07 AM »
Ann,
No, I didn't know that.  He is definitely not the type of doctor that likes to be told what to do though - no bedside manner at all.  He's always gotten defensive when I try to talk to him about anything - he asks me, "Are you a doctor"? 

I have to wait for them to come in the mail anyway.  I don't even want to take them.

Offline risred1

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #12 on: January 15, 2010, 09:03:15 AM »
Maggie, treatment can be a hard line to cross. Its a very significant moment. Many of us delay, for any number of reasons.

But at least Reyataz and Isentress are considered well tolerated and pretty much state of the art stuff that simply works to supress the virus.

If you are in fear of treatment because of the past, updating your thinking to what these drugs are and what they represent in the moment. Dipping your toe in, won't be a good thing. You do have to commit to taking these drugs every day and stick with that.

I hope some of the commentary from folks from all walks of life, helps you in resolving this demarcation in the progression of HIV infection that nearly all of us have to deal with. That moment when we have to concede that our bodies cannot control the virus well enough without these treatments.

I certainly echo Anne's sentiment. Normally a combo is 3 anti viral drugs. That is considered "standard". Mono therapy has been studied, but the history of HIV is that HIV eventually mutates to get around that one obstacle. Having 3 has been standard for a long time and while perhaps a dual therapy with two powerful performers will work, the question becomes, how long?

I've never heard of this combination. Although, why not combine the two... you might not be a doctor, nor I, but I've learned the hard way, we shouldn't be bullied into any solution, we need to be active participants. Perhaps a new doctor is in order?

The guidelines exist for a reason. So going off "script" there had better be a reason. And the doctor should absolutely share that reasoning. You being a doctor or not is irrelevant. Essentially the response is, I'm the patient, are you?
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 Forever England

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #13 on: January 15, 2010, 09:17:54 AM »
Ann,
No, I didn't know that.  He is definitely not the type of doctor that likes to be told what to do though - no bedside manner at all.  He's always gotten defensive when I try to talk to him about anything - he asks me, "Are you a doctor"? 

I have to wait for them to come in the mail anyway.  I don't even want to take them.

I don't like the sound of your doctor :o/
In asking "Are you a doctor?" he's telling you to shut up and do as he says. If you don't want to take then I'd be concerned you wouldn't adhere.
Can you switch to a doctor who'll listen and care?

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #14 on: January 15, 2010, 09:30:05 AM »
Maggie, are you aware that you are technically on a two drug regimen? The reyataz/norvir element only counts as one drug and isentress is one drug. If I were you, I'd be talking to my doctor about adding another drug from another class, even if you're resistant to that drug, just to be safe.

Ann

I don't know what I was thinking by not even noticing that, Ann.  Glad you picked that up.  That's a huge snafu, Maggie, on your doctor's part.
"Iíve slept with enough men to know that Iím not gay"

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #15 on: January 15, 2010, 09:44:16 AM »
i just called the office and left a msg. for the nurse to call me back.  He will not be happy about this - but I guess too bad.

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #16 on: January 15, 2010, 10:26:32 AM »
The nurse called back.  She said that yes, this was the correct regimen.  I asked if other people were on this and she said "yes".  She said that he is out of the office until next Tues. and she would "run it by him", but she confirmed to me that this was correct.

I have no other option for another doctor - this is the only one in this area who accepts public health (Ryan White) I guess it's called.

I am so confused.

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #17 on: January 15, 2010, 10:42:55 AM »
I know that you all are correct and HE is the one that is wrong.  I don't know what to do. 

Offline Ann

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #18 on: January 15, 2010, 11:01:00 AM »
Maggie, can you contact whomever you get your Ryan White from and explain the situation to them? Surely they won't be happy with a doctor mis-prescribing hiv meds that aren't part of an approved combo. They might be able to investigate this guy and put him under pressure to start prescribing the meds correctly.

This really sucks.

Ann
Condoms are a girl's best friend

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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 Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #19 on: January 15, 2010, 11:25:56 AM »
(( Ann ))
That would be my caseworker  -  I emailed her and explained this to her - she stuck up for the doctor, said "he knows best".  Yeah right.  There's no since in me even starting these meds.

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #20 on: January 15, 2010, 12:33:33 PM »
Can we ask where you live, Maggie?  You're getting really bad advice.
"Iíve slept with enough men to know that Iím not gay"

Offline Ann

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #21 on: January 15, 2010, 12:38:48 PM »
Maggie, what dose is your Norvir going to be? I'm wondering if he's using it as a third drug rather than a booster - which would still be odd and I don't recall ever hearing of a combo using two PIs. The "standard" amount of Norvir is 6 X 100mgs a day but this dosing is rarely used now days because of the side effects associated with this high amount. The amount used for boosting is 1 or 2 X 100mgs a day.

Additionally, here's this from the Reyataz info page:

HIV protease inhibitors can interact with Reyataz. We know that Norvir (ritonavir) increases the amount of Reyataz in the bloodstream. It is also likely that Kaletra which contains lopinavir and ritonavir, will also increase Reyataz levels in the bloodstream. Reyataz increases Invirase (saquinavir), and Lexiva (amprenavir) levels in the bloodstream. Crixivan (indinavir) should not be combined with Reyataz, as both drugs can cause increases in bilirubin levels. Aside from the Reyataz and Norvir combination, no other formal dosing recommendations have been made, but combining Reyataz with other protease inhibitors is not recommended.

So if he is using Norvir as your third med, he's still wrong.

I would suggest you send your caseworker the link to the US treatment guidelines (http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf) and possibly also this page from the Treatment Lesson here at AM.

I'd keep at her if I were you. Explain to her that you have a very real danger of developing resistance to these meds if you take this combo. If she won't listen, GO OVER HER HEAD! This is important stuff and you shouldn't have to suffer because of one incompetent doctor and one incompetent caseworker.

Hang in there hun!

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...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 Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #22 on: January 15, 2010, 02:01:56 PM »
Ann -
She hates me saying that I found stuff off the "internet"!!  Do you know of a pharmaceutical co. that I could call so I can find out myself and tell her this?  Or anywhere else to actually call by telephone?

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #23 on: January 15, 2010, 02:30:20 PM »
Miss - I'm in Illinois.

Offline Miss Philicia

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #24 on: January 15, 2010, 02:53:43 PM »
Ann -
She hates me saying that I found stuff off the "internet"!!  Do you know of a pharmaceutical co. that I could call so I can find out myself and tell her this?  Or anywhere else to actually call by telephone?

What's wrong with Ann's link to the National Institute of Health?  They make the treatment guidelines that your doctor should be following.  FORCE HIM to show you from that link where what he is proposing conforms to anything on there.  Fuck offending him.

Are you in southern Illinois or something?  I just find it weird that this is the only doctor you can see.
"Iíve slept with enough men to know that Iím not gay"

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #25 on: January 15, 2010, 02:59:26 PM »
Miss, I agree with the link that Ann provided.  You would just have to know this doctor to understand how he is. 

I have to stay in this county in IL to get care.  I can't relocate. 

I am a crying nervous wreck.

Thank you all.

Offline Inchlingblue

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #26 on: January 15, 2010, 04:00:20 PM »
In all likelihood this will be a very good combo but the fact is that there is no long-term data to support it. Don't panic, though, that never helps.

There have been several studies looking at Isentress/Reyataz (with and without a Norvir boost) when used as a "maintenance" or replacement regimen (i.e. after a period of time where a person has been on a typical 3-drug regimen and become undetectable).

It appears that Reyataz alone and Reyataz/Norvir boosts the levels of Isentress (see NATAP link below and aidsmeds.com Isentress page). I'm waiting for results to be more conclusive before seriously considering it.


LINKS:

Raltegravir (Isentress) plus Atazanavir (Reyataz) Maintenance Therapy Appears Safe and Effective in Small Study

http://www.hivandhepatitis.com/2009icr/icaac/docs/100209_a.html

Unboosted Atazanavir Plus Raltegravir Analyzed as Two-Drug Replacement Regimen

http://www.natap.org/2009/PK/PK_08.htm

If one is going to try this combo it would be best to do it under the supervision of a clinical trial, there are several ongoing that you can look into:

http://clinicaltrials.gov/ct2/results?term=isentress+reyataz

What dosages is he prescribing of each?

Since you can't take Truvada, Isentress/Epzicom would not be a bad alternative (assuming you don't have abacavir hypersensitivity). There are more grounds for prescribing this combo than the one he prescribed. Don't be afraid to ask him about Isentress/Epzicom instead of Isentress/Reyataz/Norvir:

http://www.thebody.com/Forums/AIDS/Meds/Current/Q203136.html

Bottom Line: Isentress/Reyataz/Norvir is likely to be fine, assuming you have no major PI or integrase mutations but it is highly unorthodox for your doctor to try it out on you without more data to support it. Especially since you do have a viral load, if you were undetectable it would be less of a risk.
« Last Edit: January 15, 2010, 05:15:51 PM by Inchlingblue »

Offline Forever England

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #27 on: January 15, 2010, 04:04:30 PM »
Miss, I agree with the link that Ann provided.  You would just have to know this doctor to understand how he is. 

I have to stay in this county in IL to get care.  I can't relocate. 

I am a crying nervous wreck.

Thank you all.

I know this is easy for me to say but please don't be daunted.

I hope you find the strength to calmly but firmly explain your concerns to your doctor. I'm not wise enough to understand the maths of the treatment but I know that you deserve the right treatment and a wise doctor will listen and responds to your concerns.

Offline BM

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #28 on: January 16, 2010, 06:40:44 PM »
Hi Maggie. I have been taking Isentress and Reyataz with Norvir for over a year (my other drug is Viread). I haven't had any real side effects other than a slight yellowing of my eyes and skin due to the Reyataz, which calmed down after a while. Everything I've read (and experienced) suggests this is a very easy-to-take and relatively side-effect free combination.

Just out of interest, what dose of Reyataz has your doctor prescribed?
« Last Edit: January 16, 2010, 07:04:34 PM by BM »

Offline beefbud

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #29 on: January 16, 2010, 07:52:10 PM »
OOPS!
I totally missed a key point in your original post so I deleted my response.

I hope your switch goes well!
« Last Edit: January 16, 2010, 07:56:44 PM by beefbud »
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Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #30 on: January 19, 2010, 01:34:17 PM »
the office called back.  He must have realized he screwed up.  He is also adding Epivir or Ziagen but I have to have this Hlab5701 lab test to see which drug will not mess with the kidneys.

Please tell me this sounds right.

They said one of those drugs goes through the kidneys and one through the liver.

Offline Inchlingblue

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #31 on: January 19, 2010, 02:42:39 PM »
the office called back.  He must have realized he screwed up.  He is also adding Epivir or Ziagen but I have to have this Hlab5701 lab test to see which drug will not mess with the kidneys.

Please tell me this sounds right.

They said one of those drugs goes through the kidneys and one through the liver.

There are a certain number of people who have a bad reaction to Ziagen (abacavir). In order to make sure you are not one of those people that's why they do that HLA-B*5701 test. Anyone who is going to take abacavir/Ziagen needs to have this test done first to determine if it's OK for them to take it.

For Epivir it's not necessary to have that test done but he is probably adding Epzicom which is one pill with both Epivir and Ziagen in it.

So just to be clear, will you be taking Isentress and Epzicom (assuming it's determined that you don't have abacavir hypersensitivity)? Or will you be taking Isentress/Reyataz/Norvir/Epzicom (which sounds like overkill)?

Offline Assurbanipal

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #32 on: January 19, 2010, 02:58:02 PM »
Maggie

Epivir is very similar to Emtriva, which is one of the drugs in your old Truvada regimen.  You mentioned you had kidney problems with the prior regimen and that may be why the doctor wants to avoid Epivir as long as you are not allergic to Ziagen.

I'm on Ziagen (for me it's part of my Epzicom pill, but it can be taken as a standalone as well).  The genetic test is no more complicated than getting a blood draw -- at least it wasn't for me as a patient anyway.  Iif you "pass" the genetic test the risk that you will be allergic to Ziagen goes way down, although not entirely to zero -- so you should watch out for symptoms those first few weeks.

Both Epivir and Ziagen can be risks to both the liver and the kidneys and you should make sure you have them monitored as part of your blood tests. 

There's more info in the Drugs section of this site:

Ziagen: http://www.aidsmeds.com/archive/Ziagen_1589.shtml

Epivir: http://www.aidsmeds.com/archive/Epivir_1579.shtml

General list: http://www.aidsmeds.com/list.shtml

Wishing you well
A
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 Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #33 on: January 19, 2010, 04:02:23 PM »
he said it would be isentress/reyataz/norvir and either epivir or ziagen.  

i am so lost.

i am so scared of all of this - i already have depression and anxiety - I can't take this. 
« Last Edit: January 19, 2010, 04:25:46 PM by Maggie »

Offline BM

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #34 on: January 19, 2010, 05:36:09 PM »
Seriously Maggie, the drugs are much better these days (i.e. fewer side-effects), and the ones you've mentioned are some of the best.

Offline MBK

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #35 on: February 01, 2010, 01:34:32 AM »
Hey Maggie:

I happen to be a physician (though I don't practice, I obviously make it a point to stay as current as possible on those things).

1. As far as the Atazanavir/Ritonavir (Reyataz/Norvir) combination, I would avoid it in favor or Darunavir/Ritonavir (Prezista/Norvir) mainly because of the risk of Jaundice with Reyataz. The overall safety profile of Darunavir is, in my opinion, superior to that of Atazanavir. Also, the pharmacokinetics/pharmacodynamics (how the drug works in the body and how well it attaches to the protease enzyme - both Atazanavir and Darunavir are both protease inhibitors) for Darunavir is by all accounts either equal or superior to to Atazanavir. So talk to your doctor, if Darunavir is an option over Atazanavir by all mean favor that combination.

2. I know that commonly 3 active agents are prescribed. However, there is evidence that even an unboosted (meaning does not have ritonavir as an agent that makes your body break down the protease inhibitor breakdown) PI with Raltegravir (Isentress) works pretty well. If I was on this drug regimen, I would feel pretty safe. Although I would caution you to strive for 100% adherence. Though a PI regimen tends to be more forgiving than say an NNRTI regimen, there seems to be mounting evidence that for Raltegravir, the barrier to mutuation maybe somewhat low. to summarize: take it every day as prescirbed. Don't miss a dose and you should be A-OK!

3. Given that your VL is @ 4K (thank Ann for bringing my attention to that) andIf you are already suffering from nephrotoxicity (kidneys being affected by a regimen) or nephropathy (kidneys are sick), I would very much hesitate to add Ziagen or Epivir. I think Darunavir/Norvir + Isentress is a powerful enough combination (as long as you are adherent).

While I would not want to question your doctor, I feel that he has neither done a good job of walking you through his rationale for his selection nor is his actually selection optimal. If you have to call him to bring attention to his mistake... well enough said? I can tell you one thing is for sure. The more experienced your doctor the better off you will be. The data on that is clear.

Where in Illinois are you? Chicago? If so, there are some AMAZING Dr.s up there. This guy comes across as such an ass. He should be your partner in making those decision not some kind kind of lord giving an edict.

I know it does not help a lot when someone says don't worry so I won't say it... but we are all here to help and are willing to share in our experience ;-)

Feel free to ask ;-)
« Last Edit: February 01, 2010, 01:00:40 PM by MBK »

Offline Ann

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #36 on: February 01, 2010, 06:59:05 AM »
Hey Maggie:

3. I only skimmed the whole thread... maybe you can clarify, are you currently fully suppressed (undetectable)? If so, I would feel even better about the switch to this two drug regimen. If you are already suffering from nephrotoxicity (kidneys being affected by a regimen), I would very much hesitate to add Ziagen or Epivir.


Um, maybe you should have read the whole thread. Go back up to reply #30 and re-read. :)
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Offline MBK

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #37 on: February 01, 2010, 01:01:09 PM »
Thanks for the suggestion Ann. Did so and edited my reply above ;-)

Offline Maggie

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #38 on: February 01, 2010, 06:27:19 PM »
That lab test came back.  He is now ordering 2 more - which will be 5 meds - 

Isentress 400 mg x2
Zigan 300 mg x2
Epivir 150 mg x2
Reyataz 300 mg x1
Norvir 100 mg x1.

I haven't gotten the Zigan or Epivir in the mail yet but I am not taking them.  I'm done.

Offline risred1

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Re: Isentress/Reyataz/Norvir - Nervous
« Reply #39 on: February 02, 2010, 08:48:35 AM »
Maggie, i was concerned that will all the information that is coming your way you might throw your hands up and give up....

These are just medicines. Yes are many ways to formulate a combination and there are of course many opinions as we have shared.

Depression and Anxiety can make living with HIV naturally difficult. I wish I could just give you something to hold onto that means something to you.

All I can share with you is my experience and that treatment for HIV was a good decision for me, and that getting control of the virus is and has been a new lease on life for myself.

What do you need from the board to help you?
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

 


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