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Author Topic: Please advise: New Doc is proposing Isentress and Intelence  (Read 3650 times)

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Offline boomer

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Please advise: New Doc is proposing Isentress and Intelence
« on: April 12, 2010, 05:40:33 PM »
Hi,

I had a visit with a new doc today. I am now taking Truvada, Lexiva and Norvir as well as Crestor, Levothyroxine 150mcg, Testim and Sertraline. I've been on this regimen for two months after I swapped Epzicom for Truvada. I had major fatigue issues with Epzicom and since starting Truvada I have chronic insomnia. I was given Zolpidem and then Ambien CR for the insomnia but I don't feel comfortable taking these meds as they have already shown signs of tolerance and I can't see a reasonable resolve in the future. I do not want to become dependent on sedative / hypnotics.

The new doc explained that a new regimen of Isentress and Intelence could deal with the lipid problem as well as the insomnia. Is this a viable combo? I am pos 25 years, AIDS 2 1/2 years starting with cd4 of 54 (don't know VL or %) now cd4 354 and VL undetectable. I hope I have given all the info needed and I would very much appreciate any and all informed responses.

Thanks and good wishes to all,

Boomer

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #1 on: April 12, 2010, 07:07:44 PM »
I don't think the combo of Isentress and Intelence has been studied enough (see below).

I'm on Isentress/Truvada and have no sleeping issues. I take the Truvada as part of my morning dose. Are you taking Truvada in the morning? If by any chance you are taking your HIV meds at night, I recommend taking them in the morning and see if the situation improves after at least a week, to give it some time.

LINK:

http://www.aidsmeds.com/articles/hiv_isentress_intelence_1667_16459.shtml

You might also want to ask Dr. Gallant what he thinks:

http://www.hopkins-aids.edu/q_a/index.html?categoryId=9352&siteId=7151
« Last Edit: April 12, 2010, 07:10:29 PM by Inchlingblue »

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #2 on: April 12, 2010, 07:13:41 PM »
Hi Inch,

I did switch from PM to AM schedule with no change in the insomnia. I will post the question to Dr. G.

Thank you.

Boomer

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #3 on: April 12, 2010, 08:15:26 PM »
Some general advice (which of course doesn't apply if the sleeplessness is due to a drug side effect):

When I had a problem with insomnia it took several nights of very little sleep and no ambien before I was able to overcome the problem. By the third night or so, with no daytime naps, I fell asleep peacefully and have been able to do so ever since.

Occasionally I'll wake up in the middle of the night and I make sure to remain calm, which allows me to get back to sleep in a short time. Before, when I would wake up like that I'd start stressing about being awake at 3 or 4 AM, and it made it worse.

Offline mecch

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #4 on: April 12, 2010, 09:10:09 PM »
Is that proposed regime even tritherapy?  Sounds like two drugs to me, not three.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #5 on: April 12, 2010, 09:38:35 PM »
Some general advice (which of course doesn't apply if the sleeplessness is due to a drug side effect):

When I had a problem with insomnia it took several nights of very little sleep and no ambien before I was able to overcome the problem. By the third night or so, with no daytime naps, I fell asleep peacefully and have been able to do so ever since.

Occasionally I'll wake up in the middle of the night and I make sure to remain calm, which allows me to get back to sleep in a short time. Before, when I would wake up like that I'd start stressing about being awake at 3 or 4 AM, and it made it worse.

Inch,
I turn my clock out of view, when I wake I remain calm, try not to open my eyes and just relax. I did not take Ambien last night and am going to try the same tonight. Also the new doc mentioned I could try hydroxizine (antihistamine) as a sleep aid.

Is that proposed regime even tritherapy?  Sounds like two drugs to me, not three.

Mecch,
Yup, that's two drugs. I can count. What I need to know is if it is a viable regimen.

Thanks for the responses.

Boomer

Offline mecch

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #6 on: April 12, 2010, 10:00:28 PM »
Well the knowledge bees here will kick in I hope.  I'm not that knowledgeable only 2 years HIV+ and have never heard of two-drug therapy in any country in recent years. 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Hellraiser

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #7 on: April 12, 2010, 10:06:53 PM »
Nothing to see here folks, just Inchling talking to himself!
« Last Edit: April 12, 2010, 10:12:24 PM by Hellraiser »

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #8 on: April 12, 2010, 10:07:51 PM »
Well the knowledge bees here will kick in I hope.  I'm not that knowledgeable only 2 years HIV+ and have never heard of two-drug therapy in any country in recent years.  

Yes that's true. There are some people who do well on Kaltera monotherapy and there have been some very promising early small studies that showed Isentress/Reyataz can work at continuing to suppress virus in people who were already undetectable on a 3-drug regimen (partly because Reyataz raises the levels of Isentress in the blood).

It's not standard of care to use anything less than 3 drugs at this time but I believe that will change in the near future.

For a doctor to suggest this combo is odd, especially when they have not been studied together enough and when one of those two drugs has been shown to lower the level of the other one.

I'm curious to see what Dr. G says.

I do think that in the near future we will see some accepted two-drug combos such as Isentress/Reyataz. Not for everybody but for some.
« Last Edit: April 13, 2010, 12:41:38 AM by Inchlingblue »

Offline Inchlingblue

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Offline Hellraiser

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #10 on: April 12, 2010, 10:11:59 PM »
I have no idea what you're talking about!

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #11 on: April 12, 2010, 10:15:57 PM »
I have no idea what you're talking about!

I had already put that link in a previous post. Or are you gaslighting me?  Hmmmm?  ;)
« Last Edit: April 12, 2010, 10:20:06 PM by Inchlingblue »

Offline Hellraiser

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #12 on: April 12, 2010, 10:22:22 PM »
I am completely innocent and deny all knowledge of whatever shenanigans you are accusing me of.

<3 <3 <3

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #13 on: April 13, 2010, 08:18:51 AM »
Hellraiser,

Thanks for the hijack and making light of what I consider to be a very serious and important question. I really don't get this forum sometimes.

Offline Hellraiser

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #14 on: April 13, 2010, 10:18:19 AM »
I'm not hijacking your thread buddy, I posted information that Inchling had already posted about why this combo probably isn't a very good idea, that was my mistake.  When he saw that and pointed it out I joked about it a bit.  You'll have to develop a sense of humor or life is going to suck miserably for you.

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #15 on: April 13, 2010, 10:35:24 AM »
I'm not hijacking your thread buddy, I posted information that Inchling had already posted about why this combo probably isn't a very good idea, that was my mistake.  When he saw that and pointed it out I joked about it a bit.  You'll have to develop a sense of humor or life is going to suck miserably for you.

Hellraiser,

First off, I'm not your buddy. Secondly, what the fuck do you know about my sense of humor or anything about my life. I posted a VERY SERIOUS question in what I thought was an appropriate forum. Your "humor" escaped me.

I am hoping to receive serious,informed, experienced, knowledgeable responses to my question.

Boomer


Offline Matty the Damned

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #16 on: April 13, 2010, 11:08:53 AM »
Hellraiser,

First off, I'm not your buddy. Secondly, what the fuck do you know about my sense of humor or anything about my life. I posted a VERY SERIOUS question in what I thought was an appropriate forum. Your "humor" escaped me.

I am hoping to receive serious,informed, experienced, knowledgeable responses to my question.

Boomer



Hey Boomer,

Chill babe! :)

I'm sure Trey (Hellraiser) didn't mean any harm.

MtD

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #17 on: April 13, 2010, 11:11:23 AM »
MTD,
YOU FUCKING CHILL. IF YOU DON'T HAVE A WORTHWHILE COMMENT WHY DON'T YOU JUST LEAVE IT BE.

Offline Matty the Damned

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #18 on: April 13, 2010, 11:16:15 AM »
MTD,
YOU FUCKING CHILL. IF YOU DON'T HAVE A WORTHWHILE COMMENT WHY DON'T YOU JUST LEAVE IT BE.

Sure thing.  :-\

MtD

Offline Tim Horn

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #19 on: April 13, 2010, 11:21:48 AM »
Boomer:

It looks as if you're getting some decent information here, so please don't become upset by a seemingly innocuous hijack -- it's just not worth it. I'm sure Hellraiser will keep his trap shut for the remainder of this thread, unless he has something of substance to add. And while it might have been better for Matty to leave well enough alone, there was no reason for you to lash out like that -- it's not helping matters at all.  

Just let it be, okay? If you don't get the quantity or quality of responses you're hoping for, just let me know and I'll lock this one up and have you start another thread.  

Tim

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #20 on: April 13, 2010, 11:32:45 AM »
Hold on man, just take it down a notch or two.  These forums are a community of individuals who will gladly help you, but you have to realize that we're people too.  We're going to be a little affable and jocular as we're not doctors and this isn't our job.  I'm hoping that you got some answers to your question earlier in the thread, but you should see that we like to have a little bit of fun on here as well.  Now I apologize if I offended you by making light of the subject matter, but you should realize that I was in fact attempting to help you.  Just let go of the anger that you seem to be directing at all of us.  It seems misplaced as we did nothing to warrant that kind of response.

Hellraiser,
You may have noticed that I fall into that category of people that DO NOT LIKE TO BE TOLD WHAT TO DO!

I posted a serious question in the "Treatment and Side Effects" forum NOT "Off Topic" or even "living With" as there is certainly some humor to be found in the day to day issues of HIV / AIDS. I am angry with you for the obvious. I have valid and reasonable reasons why I am anxious and stressed but feel no obligation to provide you with the details. It is incidents like this that really turn me off to this site. My god, you can't even apologize without making excuses and supporting your actions.

There is a time and place for everything. Too bad for you that you are too shallow to know the difference. So much for this being a "refuge", a place of good information, knowledge and experience.

Boomer

Offline Tim Horn

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #21 on: April 13, 2010, 11:42:49 AM »
And to bring this back on track...

As Inching points out, Isentress plus Intelence -- especially without other meds in the mix -- raises all sorts of red flags. It's one thing to consider a two drug combination, but it's another thing entirely to consider a two-drug combination involving these particular meds:

1) The potential drug interaction between the two. If you're using a two-drug regimen, you want to be sure that drug levels are maximized in the bloodstream. The fact that Intelence significantly reduces Isentress concentrations, at least in the pharmacokinetics study completed thus far, is troubling.

2) Low barriers to resistance. Though Isentress and Intelence are highly effective, they both suffer from relatively low resistance barriers. Unlike resistance to the protease inhibitors (notably Norvir-boosted PIs), which require a number of different HIV mutations, resistance to Isentress and Intelence can be much more rapid and complete, given that fewer mutations are required. Staving off mutations with a three-drug regimen, especially when there are negative interactions between two of the drugs being used, is undoubtedly best.

Tim 


Offline Tim Horn

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #22 on: April 13, 2010, 11:46:50 AM »
One more thing...

Have you and your doctor considered levothyroxine as the reason for your insomnia? There's plenty of literature linking levothyroxine and sleep disturbances.

Tim

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #23 on: April 13, 2010, 11:53:56 AM »
One more thing...

Have you and your doctor considered levothyroxine as the reason for your insomnia? There's plenty of literature linking levothyroxine and sleep disturbances.

Tim

Interesting. I may have to go on thyroid replacement and did not know that.  Apparently it could be an indication that the dosage is too high:

When taking levothyroxine, insomnia is a possible side effect. However, if you develop insomnia while taking levothyroxine, it may be an indication that your dosage is too high (as insomnia is a side effect of hyperthyroidism). If you are taking levothyroxine and insomnia becomes a problem, talk to your healthcare provider. He or she can recommend possible treatment options.

LINK:

http://endocrine-system.emedtv.com/levothyroxine/levothyroxine-and-insomnia.html

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #24 on: April 13, 2010, 11:56:13 AM »
Tim,
Funny you should mention the thyroid med, the new doc mentioned my current dose (150mcg) was high.
I will follow up with him on that and hope I can get some further feedback on the proposed new regimen. I am awaiting a response from Dr. Gallant (thanks Inch) on the Isentress / Intelence combo.

Boomer

Offline Tim Horn

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #25 on: April 13, 2010, 12:02:47 PM »
Boomer:

Also know that androgen therapies -- such as Testim -- can induce hyperthyroidism. In turn, Testim may be exacerbating the effects of levothyroxine (and vice versa).

Checking your thyroid function would certainly be a good first step; reducing your dose of levothyroxine may also be in order.

Tim


Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #26 on: April 13, 2010, 12:08:49 PM »
Ahhh, the joy of med interactions.

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #27 on: April 13, 2010, 12:34:26 PM »
I live in a rural area of upstate New York. I have been traveling over 200 miles round trip for care in New York City with an ID doctor I adore but he has recently made staff changes that have left me feeling less than well served. On top of that I am rapidly approaching bankruptcy and a possibility of losing my home. I have recently signed up with a local ASO and am in the process of applying for ADAP as I have just qualified Medicare (after 2 years on SSDI). I have been having MAJOR problems with private insurance reimbursement claims as well as with my mail order pharmacy. Managing my healthcare has become a full time, frustrating, stressful nightmare. While I am grateful for what I have, sometimes it is difficult to deal with the constant barrage of paper work, phone calls, waiting cues, emails, faxes etc. Not to mention medication side effects, depression, bills, bullshit, etc.

In my home area there is one HIV/AIDS doctor and because of financial reasons I am forced to consider him. So I was happy to feel comfortable with him yesterday during our first visit. He spent over an hour with me, was attentive, personable (although this is at the bottom of my list of requirements) and has a what appears to be a good staff.

I came home feeling good about the change (in spite of the fact that I really have no choice in the matter and as some of you may know, "I HATE BEING TOLD WHAT TO DO") but was shocked and dismayed when I read up on his proposed new regimen of Isentress / Intelence. His reasoning was that I could not only resolve the new insomnia issue with Truvada but also address the cholesterol and triglyceride side effects of the PI's and do away with the Crestor that I now take. It sounded great.

So now, I feel overwhelmed and beaten down. I am going to gather  some more information and then have a discussion with the new (maybe) doc.

Thanks to all (almost)- I couldn't resist ;)

Boomer  
« Last Edit: April 13, 2010, 12:37:36 PM by boomer »

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #28 on: April 13, 2010, 12:48:00 PM »
Have you checked the website

www.aahivm.org

You can search for HIV docs by city/zip codes; who knows, you may find another one that isn't too far?

You can also check if the one you found who suggested this new combo is listed as a member. Not all good HIV docs are necessarily part of this organization so if a doctor is not on it it doesn't automatically mean they are not competent but the fact is that the AAHIVM requires their members to have a certain level of knowledge and experience treating HIV so choosing from their members provides at least some level of comfort.

 
« Last Edit: April 13, 2010, 12:50:23 PM by Inchlingblue »

Offline boomer

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #29 on: April 14, 2010, 07:20:04 PM »
Hey all,
I am waiting for Dr. Gallant's response to my question and in the mean time I did call the new doc. He explained that he had about 6 patients on the Isentress / Intelence regimen and they were doing well. Of course that is a very general statement and not of much use without the specifics and labs. But he does have patients on this regimen. He assured me not to hesitate to ask questions and all was at my comfort level. He was quick to return the phone call and did not rush me during the conversation so I am going to make the switch, as I really have not much of a choice and see where it goes.

Additionlly, I discussed the Testim and Levothyroxine situation and we decided to stop the Testim for a week and see what happens. Next would be the Levothyroxine so as to determine if either or both of these meds are the culprit for the insomnia. If not, it's definitly the Truvada. I went without the Ambien last night and was able to manage the wakefull times calmly.

I'll post when I hear from Dr. Gallant.

Take care,

Boomer

Inch,
I did check the aahivm website and not only was the new doc not on there but neither was my (soon to be) old one. As a matter of fact there isn't one less than 90 miles away. Thank you just the same. :)

Offline mecch

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #30 on: April 14, 2010, 07:34:15 PM »
Why do you say you have no choice but to take this proposed treatment?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Inchlingblue

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Re: Please advise: New Doc is proposing Isentress and Intelence
« Reply #31 on: April 14, 2010, 08:00:50 PM »
Hey all,
I am waiting for Dr. Gallant's response to my question and in the mean time I did call the new doc. He explained that he had about 6 patients on the Isentress / Intelence regimen and they were doing well. Of course that is a very general statement and not of much use without the specifics and labs. But he does have patients on this regimen. He assured me not to hesitate to ask questions and all was at my comfort level. He was quick to return the phone call and did not rush me during the conversation so I am going to make the switch, as I really have not much of a choice and see where it goes.

Additionlly, I discussed the Testim and Levothyroxine situation and we decided to stop the Testim for a week and see what happens. Next would be the Levothyroxine so as to determine if either or both of these meds are the culprit for the insomnia. If not, it's definitly the Truvada. I went without the Ambien last night and was able to manage the wakefull times calmly.
 

There are several red flags here. Not only the highly unorthodox use of Isentress/Intelence as duo-therapy but it's generally not advised to stop testosterone cold turkey but rather taper off instead.

LINK:

http://forums.poz.com/index.php?topic=30427.msg372753#msg372753

I urge you to do a little more research and to think about this a little longer before committing.

 


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