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Author Topic: Undectectable... future meds choices  (Read 3359 times)

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Offline LordBerners

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  • Posts: 415
Undectectable... future meds choices
« on: May 11, 2010, 04:25:59 AM »
I just visited the doctor, where I learned that my last blood drawing (six months ago) showed undetectable.  Great news!  Also my CD4s were just a little lower, I think around 550 from 600 (approximating from memory), and the percentage 28 from 30.  So pretty good.

I also learned I should have free meds for another 6 months.  After that I must pay if I continue this regimen.

Regarding that, my choices are to continue the current regimen - Abacavir/Atanazavir/Norvir/Tenofovir - and pay around $600/month, or make up a new regimen out of meds the Red Cross can either give free or at very low cost, namely:

Kaletra/Tenofovir/Zidovudine.  The first two being available free for the moment, the last costing only around $30/month. 

So, its a tough choice - spend a lot on a combo that gives me no side effects, or try a new one that is probably very side-effect prone but essentially free.  Anyone have any opinions about Kaletra and AZT?  Pretty scary I guess.
Please, just call me Berners.. or Baron.

Offline TabooPrincess

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  • Posts: 279
Re: Undectectable... future meds choices
« Reply #1 on: May 11, 2010, 04:45:57 PM »
I had both of those during pregnancy - the AZT gave me no side effects at all and the kaletra just really bad squits.  It's a tough decision for you, it's a shame that you have to make it.  I'd be tempted to stick with what I know works but then I don't need to worry about paying for meds here.  That's a ridiculous amount to pay but then it's for your health.  Hmmmmm.  Let us know what you decide.
09/ 2008 - Seroconversion
11/2008 - Tested pos, cd4 640 vl 25400
12/2008 - cd4 794 vl 27798, 35%
03/2009 - cd4 844 vl 68846, 35%
06/2009 - cd4 476 vl 49151, 33% (pregnancy confirmed)
08/2009 - cd4 464 vl 54662, 32%
Started meds for pregnancy (Kaletra, AZT, Viread)
09/2009 - cd4 841 vl 3213, 42%
10/2009 - cd4 860 vl 1088, 41%
11/2009 - cd4 771 vl 563, 38%
12/2009 - cd4 885 vl 151 42%
Discontinued meds after baby born
02/2010 - cd4 841 vl 63781, 38%
05/2010 - cd4 1080 vl 113000, 39%
08/2010 - cd4 770 vl 109242
12/2010 - cd4 642 vl 111000, 34%
06/2011 - cd4 450 vl 222000, 33%
11/2011 - cd4 419 vl 212000, 24%
03/2012 - cd4 280 vl 118000, 26% (repeated Cd4 at 360)
05/2012 -cd4 360 vl 99,190
10/2012 Atripla, cd4 690, vl 80
12/2012 Darunavir, norvir, truvada, Cd4 680, vl u/d
07/2013 cd4 750,ud

Offline LPinUK

  • Member
  • Posts: 58
Re: Undectectable... future meds choices
« Reply #2 on: May 11, 2010, 04:59:07 PM »
I think it depends on your financial situation , if that amount of money leaves you broke for the rest of the month then don't do it, if on the other hand you still have enough to live the life you need to then I would consider the better meds.

I'm happy I live in the UK and don't have to make such tough decisions.

Good Luck
Diagnosed Poz September 2003, Current Regimen Truvada & Sustiva.

Offline LordBerners

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  • Posts: 415
Re: Undectectable... future meds choices
« Reply #3 on: May 12, 2010, 01:45:12 AM »
... I'd be tempted to stick with what I know works but then I don't need to worry about paying for meds here.  That's a ridiculous amount to pay but then it's for your health.

I'm happy I live in the UK and don't have to make such tough decisions.

Yes, count yourselves lucky you are not American.  As for the cost, the $600/month is the price here in Thailand - back in the USA it would be several times that!

I'm concerned about the Kaletra diarrhea, but also the likelihood of body malformations due to the AZT.  My doctor seems to be skeptical of my current combo, as she says it is a fairly 'weak' one, and prone to failure (I have read that), and it did take a very long time to get me to undetectable.
Please, just call me Berners.. or Baron.

Offline Hellraiser

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  • Semi-misanthropic
Re: Undectectable... future meds choices
« Reply #4 on: May 12, 2010, 11:06:15 AM »
Yes, count yourselves lucky you are not American.  As for the cost, the $600/month is the price here in Thailand - back in the USA it would be several times that!

I'm concerned about the Kaletra diarrhea, but also the likelihood of body malformations due to the AZT.  My doctor seems to be skeptical of my current combo, as she says it is a fairly 'weak' one, and prone to failure (I have read that), and it did take a very long time to get me to undetectable.

AZT = Zidovudine right?  I think that the doses are lower so the side effects might not be as severe these days?  I have an innate fear of AZT though, that would be a last resort treatment option for me.  What you can afford is what you can afford however.

Offline MitchMiller

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  • Posts: 479
Re: Undectectable... future meds choices
« Reply #5 on: May 13, 2010, 03:06:00 AM »
Lord:

I thought Thailand produced its own generics?  Is that not so?

$600 USD/month is an outrageous price for a generic regimen.

Offline dist

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  • Posts: 11
  • Italian male. If you want to know more, just ask.
Re: Undectectable... future meds choices
« Reply #6 on: May 13, 2010, 08:12:56 AM »
I think it depends on your financial situation , if that amount of money leaves you broke for the rest of the month then don't do it, if on the other hand you still have enough to live the life you need to then I would consider the better meds.

I'm happy I live in the UK and don't have to make such tough decisions.

Good Luck

In Europe (I live in Italy), the problem with Hiv therapy is not related to a lack of drugs or the cost of drugs. However, US guidelines are more up to date than the European ones. For example, Kaletra is still a "recommended" drug (while Isentress is an "alternative" drug) for na´ve patients.
Everyone should be given the right to the best medical care available, regardless of economic conditions.
oct08         hiv negative
jan09         tested positive
feb09         cd4 621   vl 17000    no meds
may09        cd4 604   vl 4200     no meds
aug09         cd4 578   vl 6440     no meds
nov09         cd4 489   vl 52800   no meds
feb10          cd4 522   vl 372000  no meds
mar16, 2010 started on Isentress and Truvada
apr10           cd4 500   vl <50
may10          cd4 501   vl <50
aug10           Not Yet Available
nov10           Not Yet Available

Offline dist

  • Member
  • Posts: 11
  • Italian male. If you want to know more, just ask.
Re: Undectectable... future meds choices
« Reply #7 on: May 13, 2010, 08:24:48 AM »
I just visited the doctor, where I learned that my last blood drawing (six months ago) showed undetectable.  Great news!  Also my CD4s were just a little lower, I think around 550 from 600 (approximating from memory), and the percentage 28 from 30.  So pretty good.
(...)

I am on a different regimen, Isentress + Truvada, but the first result after I have started this treatment showed a similar decrease of CD4s. I don't know the reason and I just hope I will see an increase as soon as possible.  ::)
oct08         hiv negative
jan09         tested positive
feb09         cd4 621   vl 17000    no meds
may09        cd4 604   vl 4200     no meds
aug09         cd4 578   vl 6440     no meds
nov09         cd4 489   vl 52800   no meds
feb10          cd4 522   vl 372000  no meds
mar16, 2010 started on Isentress and Truvada
apr10           cd4 500   vl <50
may10          cd4 501   vl <50
aug10           Not Yet Available
nov10           Not Yet Available

Offline LordBerners

  • Member
  • Posts: 415
Re: Undectectable... future meds choices
« Reply #8 on: May 13, 2010, 01:13:37 PM »
Lord:

I thought Thailand produced its own generics?  Is that not so?

$600 USD/month is an outrageous price for a generic regimen.

I do think some generics are available in Thailand, Mitch, but I know that the meds I'm being offered are 'original'. 

However I've been told $600 is the cheaper 'Thai price', as these meds would cost several times that amount in the US.  When I checked the same set of medications at online pharmacies that sell Indian-made generics, the price was roughly the same $600/month.

The tenofovir is pretty cheap, but the other two are high - the Reyetaz and the Abacavir, each around $260-280/month.  If anyone knows of any cheaper versions of these somewhere, please let me know, but I think that's as cheap as they get.
Please, just call me Berners.. or Baron.

Offline blackwingbear

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  • Posts: 363
  • Hello, all you happy people....
    • THE DARK MIND OF BLACKWINGBEAR
Re: Undectectable... future meds choices
« Reply #9 on: May 14, 2010, 12:54:46 PM »
AZT = Zidovudine right?  I think that the doses are lower so the side effects might not be as severe these days?  I have an innate fear of AZT though, that would be a last resort treatment option for me. 

You're not alone in that - I knew of too many people that AZT did horrifying things to them & many of them are no longer here. Might be illogical, but for those reasons I don't think I could do AZT...
It's all a sham. Politics is a big game, same as the media - and same as religion. The point is to distract & control. If we're looking at what they tell us is the "big issue", we're not looking at what they are doing. In time, there will be different causes and different minorities to pick-on. All in the name of keeping the system going, and the people distracted.

Offline edfu

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  • Posts: 1,084
Re: Undectectable... future meds choices
« Reply #10 on: May 15, 2010, 05:04:18 AM »
The AZT dosage prescribed today is much, much lower than that used in the early days, when AZT monotherapy at a very high dosage proved to cause a lot of damage.  In my own experience, however, AZT is a lousy drug.  I was in an AIDS clinical trial (ACTG 5095) from 2002 to 2005, and AZT was one of the drugs (after the trial was unblinded, I learned that I was on Sustiva + Trizivir).  I began with a CD4 of 29, and three years later it never rose much above 300.  When the trial ended in 2005, and I had to select what drug regimen I would take outside of the trial, I decided to drop the AZT and substitute Epzicom.  Three months after this change my CD4's rose to 500, around which they've stayed.   

As far as I'm concerned, the only change that caused such a large CD4 increase was my stopping the AZT.  (Trizivir = AZT + abacavir +  lamivudine.  Epizicom = abacavir + lamivudine.  So I literally went from four drugs to three.)     
 
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline dist

  • Member
  • Posts: 11
  • Italian male. If you want to know more, just ask.
Re: Undectectable... future meds choices
« Reply #11 on: May 15, 2010, 06:11:09 AM »
When the trial ended in 2005, and I had to select what drug regimen I would take outside of the trial, I decided to drop the AZT and substitute Epzicom.  Three months after this change my CD4's rose to 500, around which they've stayed.    

Some research studies suggested that abacavir might increase the risk of heart problems. Why don't you try Isentress + Truvada?  :)
oct08         hiv negative
jan09         tested positive
feb09         cd4 621   vl 17000    no meds
may09        cd4 604   vl 4200     no meds
aug09         cd4 578   vl 6440     no meds
nov09         cd4 489   vl 52800   no meds
feb10          cd4 522   vl 372000  no meds
mar16, 2010 started on Isentress and Truvada
apr10           cd4 500   vl <50
may10          cd4 501   vl <50
aug10           Not Yet Available
nov10           Not Yet Available

Offline MitchMiller

  • Member
  • Posts: 479
Re: Undectectable... future meds choices
« Reply #12 on: May 15, 2010, 01:51:20 PM »
Lord:  It just registered with me that you shouldn't be combining Abacavir and Tenofovir.  I was in this clinical study where it failed.  I'm surprised your doc would combine the two.  A subsequent study showed that adding AZT to the regimen might compensate for the interaction.  There's a lot of info on the web about this, but here's a couple articles to consider:

http://www.thebody.com/content/art15929.html
http://www.liebertonline.com/doi/abs/10.1089/apc.2006.0070

Also Abacavir has its problems with arterial inflammation, but tenofovir (in Truvada) has also been shown to cause kidney damage:
Tenofovir toxicity risk

http://www.i-base.info/pub/htb/v4/htb4-5/Tenofovir.html

"In analysing the data, the Vancouver researchers found that tenofovir users were about three times more likely than abacavir (ABC, Ziagen) users to develop higher-than-normal levels of creatinine in their blood. Another factor linked to having this problem was low CD4+ counts, roughly fewer than 150 cells. All in all, about 7% of tenofovir users in the Vancouver study developed some degree of kidney damage over an average of six months. A total of six patients had to stop taking tenofovir because of injured kidneys."
« Last Edit: May 15, 2010, 01:52:55 PM by MitchMiller »

Offline LordBerners

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  • Posts: 415
Re: Undectectable... future meds choices
« Reply #13 on: May 15, 2010, 03:02:33 PM »
Thanks Mitch.  Yes my doc has mentioned that my combo is a 'substandard' one.  I think that's one reason she's suggesting changing when my period of free meds comes to an end.  I'm definitely considering it.

I wonder if I changed to the AZT and Kaletra as she suggested, if there would be any other option than tenofovir for the third drug.  I'm resistant to a number of drugs already (including 3TC).
Please, just call me Berners.. or Baron.

Offline elf

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  • Posts: 607
Re: Undectectable... future meds choices
« Reply #14 on: May 18, 2010, 09:58:27 PM »
I'm on Kaletra and have no diarrhea.
Diarrhea occurs only when I have too much diet Coke.
The main problem with Kaletra is blood lipid change.
First it gave me hypertriglyceridemia, after I started taking omega-3,
my triglycerides went back to normal range, but my cholesterol soared.  >:(
I took Kaletra twice daily with lamivudine+zidovudine (Combivir) for a year,
and have changed it to: once daily Kaletra + Kivexa/Epizicom.
This combo is ok with body modifications but very heart attack inducing :(

The good thing with Kaletra: once-a-day dosing seems fine:
http://www.aidsmap.com/en/news/80DF2180-8261-44CB-BABC-7E1CD7FA4758.asp
« Last Edit: May 18, 2010, 10:04:51 PM by elf »
Let's have a Kiki!

Offline Inchlingblue

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Re: Undectectable... future meds choices
« Reply #15 on: May 18, 2010, 11:11:08 PM »
Isn't there Kivexa (abacavir/3TC, a/k/a Epzicom)  in Thailand?

Reyataz (atazanavir) with Epzicom does not have to be boosted by Norvir so it would only be the two pills comprising three drugs.

It makes no sense to have you on abacavir and tenofovir. Maybe you have resistance to 3TC?

Offline LordBerners

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  • Posts: 415
Re: Undectectable... future meds choices
« Reply #16 on: May 19, 2010, 10:45:00 AM »
Isn't there Kivexa (abacavir/3TC, a/k/a Epzicom)  in Thailand?

Reyataz (atazanavir) with Epzicom does not have to be boosted by Norvir so it would only be the two pills comprising three drugs.

It makes no sense to have you on abacavir and tenofovir. Maybe you have resistance to 3TC?

Yes, I'm resistant to 3TC.
Please, just call me Berners.. or Baron.

Offline Inchlingblue

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Re: Undectectable... future meds choices
« Reply #17 on: May 19, 2010, 11:16:18 AM »
Yes, I'm resistant to 3TC.

If your resistance is due to the M184 mutation you may still benefit from taking 3TC. I suppose it would take a knowledgeable doctor to know whether Reyataz/Kivexa (Epzicom) could still work for you, probably with the Norvir boost to give it more strength.

I know someone with M184 who is on Reyataz/Norvir/Kivexa (Epzicom) and doing great.

LINK:

http://newbioafrica.mrc.ac.za/hivdb/pages/GRIP/3TC.html

 


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