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Author Topic: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)  (Read 67954 times)

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Offline eric48

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  • Posts: 1,264
With 4 parameters I can fit an elephant. With 5 I can make it wiggle his trunk

recommended reading
Dynamics of Cancer : Incidence, Inheritance, and Evolution by Steven A Frank
http://tinyurl.com/cm8blnc

Dynamics are generally speaking less known to the public. No need to read in detail, just browse thru
This book emphasize the use of speeds (time derivatives) and acceleration, just as we did in previous posts, as a framework for better model validation.

Having a model would be more fun if it were predictive: let's give it a try

Forecast for upcoming blood draw (aka ImmunoForecast)

CD4 % around 49
CD4 > 1100 but less than 1300; estimated at 1100
CD8 % around 23
CD8 estimated at 520
CD4/CD8 around 2.1

Still open:
Quiz : In CD4, what means C , D and 4 ?

« Last Edit: May 06, 2014, 09:24:26 PM by Jeff G »
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Hellraiser

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Quiz : In CD4, what means C , D and 4 ?

Cluster of Differentiation 4

Offline eric48

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  • Posts: 1,264
We have not finished. Meds have cured noone (*). And that is the problem

(*) with exception of Viscontis and a handfull of others

Thanks ! Yep ... See:
http://en.wikipedia.org/wiki/CD4

No room on a post like this to explain C and D, but maybe one can easily explain the 4 (in relation to 8)...

Since my previous post included a prediction and blood test was done May 12, I now know the quality of the prediction exceeds my expectations. In order to set expectations right I have published a foreword to put in perspective how a predictive model should be tested and prove its worth.

Here again there is no room here to publish this (too many numbers), so I have published on the Tumblr account. I am new to Tumblr so there is a learning curve. Also I'll wrap this up into graphs , easier to read, but this takes time ...

www.tinyurl.com/HIVPharmaCure-T1

I'll post the graphs here as well.

Visit to Doc:  UD as usual...
He offers Complera, but, no, I want to stay on Viramune. I am starting using generics (Mylan) and I want to report to fellow Viramune users

May 12 started  Boneozard

Quiz : In CD4, what means 4 ?

Stay tuned : @HIVPharmaCure (pls RT)       Cheers ! Eric
pointer : http://tinyurl.com/HIVPharmaCure-24 (please do not copy, do not highjack, thanks!)
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline eric48

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just to add : I have kept this thread active for four years : this is the 4 y. anniversary
Also I'd like to change the quiz question from
Quiz : In CD4, what means 4 ?
to Quiz : In CD8, what means 8 ?  Eric
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline ad2san

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  • Posts: 203
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #154 on: September 07, 2014, 05:52:06 AM »
I think the name CD4 and CD8 is because of there shape ?
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%
Oct 2013 CD4 588 UD 39%
Aug 2014 CD4 639 UD 25%
Switched January 2015 to Triumeq
May 2015 CD4 807 UD 31%

Offline eric48

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  • Posts: 1,264
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #155 on: November 06, 2014, 01:15:33 AM »
I think the name CD4 and CD8 is because of there shape ?

Took me a hell of a time to figure out what you might mean by 'there shape'
I found nice pics to illustrate the 'shape' thing , which I have on another PC. I ll get to it...
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

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  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #156 on: April 05, 2015, 05:29:15 PM »
Hey peeps,

Let's see if anyone is still active on this topic, which was extremely pleasant to read...

I am on this combination of meds for four weeks now. And all goes well, it seems, well, we'll see that in two weeks after the next bloodtests. The two-weeks-test showed that liver and kidney are doing well.

Maybe someone can reflect on the things that keep me busy.

1. I feel scared a lot more then before. Seems I think a lot about things that can go wrong, anxiety. I can see my fear is silly, but that doesn't make it less unpleasant.
- is it related to these meds?
- anything I can do about it? (Preferably not adding other meds)
- suggestions, thoughts?
- does it get better later on?

2. Anyone takes them before going to bed? How is that? I take them at ninet in the morning now, but after one hour I feel a bit drugged for a while. Groggy is the term I think. Can I perhaps solve that by taking the meds at 0:00 hrs?

3. I am supposed to take my meds within 60 minutes from the same moment during the day, says my doctor. What if I want to switch to another moment in the day, take a double dose or just miss a few hours.

No worries, I will always double check questions and answers with my doctor anyway, but I would like to have a channel to reflect on all of it during this process.

Thanks people. Plz be kind.
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline ad2san

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  • Posts: 203
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #157 on: April 06, 2015, 02:04:47 AM »
Hi there, I was on this combo.

1) no scare or something like it on my side. Maybe should you talk with a counselor.
2) I always take the med in the morning because I am almost always home at breakfast and have the pills in a hand reach.
3) the 60mn stuff is theoreticall. Don't polite your life counting the minutes, just take your pills when you go to bed.

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%
Oct 2013 CD4 588 UD 39%
Aug 2014 CD4 639 UD 25%
Switched January 2015 to Triumeq
May 2015 CD4 807 UD 31%

Offline eric48

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  • Posts: 1,264
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #158 on: April 06, 2015, 05:15:41 PM »
1. I feel scared a lot more then before.

2. Anyone takes them before going to bed?

3. I am supposed to take my meds within 60 minutes

Thanks people. Plz be kind.

Hi there,

I have been overall happy with this combo, and I am still on it. no reasons to change.

I have used Viramune 200mg (twice daily) then Viramune 200 mg (all at the same time, 6 months after treatment initiation), then when it became available, I have used Viramune 400 mg XR, and since they became available here, I am using Nevirapine (generic) 2x 200 mg at one dosing a day.

Because 200mg can be taken all in the morning (or night) or 1 in the morning and 1 in the evening, I could play around to see what is causing what.

I did have extra anxiety (it has resolved since) for quite while and attributed it to Kivexa.

Therefore, in order to get a good sleep I take my meds in the morning. At one point I was taking them very early, but, as I said things have come back to normal, so now, I take any time in the morning.

Virumune has a very long half life. In women taking a one time one pill during baby delivery, it has been observed that it was still detectable in blood one month after the one and only dose.

ABC and 3TC (components of Kivexa) both have shorter half lives in serum but higher than (previously) thought intracellular life.

So the rule of thumb is to be strict on schedule at the begining, as your Dr prescribed, until you are UD.
Then, once UD, you can relax and take any time during the designated half of the day.

There are not too many combos that allow this flexibility and do not have meal obligation, so that one fits my lifestyle.

My immunologic response has been excellent. It takes time, of course... But my numbers are in noway different from those of your average HIV negative person.

Of course, I have had my ups and down, but, I have always kept in mind the comment of one poster in this thread
http://forums.poz.com/index.php?action=post;quote=416424;topic=33062.0

Now, consider yourself lucky to be on it... I have been on MANY other combos, .... This one is just .... a dream come through for me.
I surely hope you can stay on it...
xx hermie

I must say, I am grateful to those who encouraged me by posting in this thread.
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

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  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #159 on: April 06, 2015, 05:29:43 PM »
Thank you two. Very clear info, which makes sense.

I think i'll stay connected to this topic for a while. Feels good.
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline eric48

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  • Posts: 1,264
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #160 on: April 06, 2015, 05:38:19 PM »
Yes... feel free to do so... You are living in a 'rich' country where lab test are readily available.

This combo is also used in less rich countries and people rely on the internet to learn about this combo, which, is available everywhere, but gets little media attention (since the original manufacturer is not really interested in the promotio of a molecule that has become generic)

It would be nice, therefore, for the benefit of those who do not have access to more modern drug to learn from the experience of users.

This combo is not widely popular. but this thread is the most viewed in this section of the forum (62.000 views as of today)
So it would be nice to revive it a bit 
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

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  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #161 on: April 06, 2015, 06:20:30 PM »
Deal. I'll post my data here. Always good to reflect on it.
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline Saintfranciscus

  • Member
  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #162 on: April 19, 2015, 01:37:04 PM »
I will get my results this wednesday.

Anyone experience weight gain due to these meds or am I eating too much?
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline eric48

  • Member
  • Posts: 1,264
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #163 on: April 20, 2015, 03:12:41 PM »
Not so much of a problem here, at least for the first 2-3 years.

You may want to be careful though. Rats fed with Nevirapine (aka Viramune) had a tendancy to over-eat.

It takes a while for the liver to adjust to the medication.

From your post, I understand that you are not reporting any rash. So most likely you are on the safe side for this by now.
Your doctor will check you liver enzyme and tell you if it is OK to proceed and ramp up to 400 mg / day (the normal dose)

Once you have passed that, most of the good work is done with Viramune. and is unlikely to be a concern in the future.

You should remain on the watch out for Abacavir hypersensitivity reaction that may appear in the first 2 months. But this is very rare...

So let's see what the doc says about the liver and things will proceed from there.
Keep posting the good news !

Cheers! eric
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

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  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #164 on: April 20, 2015, 05:32:40 PM »
Hey there!

I think I'm passed that. They firstly did a test to see if I am allergic for that substance you are aiming at. And then the step from 200 to 400 mg exactly as I read in your previous posts.

About the hipfatties: I think it's spring probably, I eat too much. I will do more sports then.

I heard somewhere that getting to UD takes longer with this regimen. Is there any knowledge on this? And that the viral load figure can be somewhat unsure due to NRA. I dont even know what that is actually, does this ring any bells?

Again, reading this forum feels good. I have decided to tell no one about all this, but this way I feel i'm not alone at all.

I'm very curious for the CD4 and VL.

Banzai!
Greetz,
Francis
« Last Edit: April 20, 2015, 05:40:09 PM by Saintfranciscus »
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline Saintfranciscus

  • Member
  • Posts: 15
Re: 06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)
« Reply #165 on: April 22, 2015, 06:19:19 AM »
Hey peeps,

The doctor said the results are excellent.

Viral load dropped from 141000 in feb. to 1040 now.
CD4 grew, allthough I don't quite understand how this figure works, from 0,33 to 0,60. (Apparently the treshold is 0,40)

So the treatment is going well, liver and kidneys are managing well, and weight gain can be the result of a body that no longer needs to fight an infection as much as before. He called an infection 'an unhealthy way of weightloss' since it burns calories.

Okay that's it. All good it seems. Hmmm... I just realised that I haven't had sex since this all started... Djeez, I'm becoming a nun.

Greetings!
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline Saintfranciscus

  • Member
  • Posts: 15
Hey,

I have the idea my heart has to work a lot harder. Even when I am lying in my bed  resting I have a heartrate of 80 beats per minute. But it's also the first time in months without stress. That and the meds are potential causes I can list...

Anyone any experience with this?

Greetz,
Francis
« Last Edit: May 18, 2015, 04:23:27 PM by Saintfranciscus »
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline eric48

  • Member
  • Posts: 1,264
Yes... I have had that too... I had periods where this happened for a few weeks, then it went away, then came back. Even at rest heart beat was 100 at times. Doc. did not seem alarmed, though

I don't have this any longer ... Last year I had periods were Blood Pressure was higher for a few weeks , but that has gone too...
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

  • Member
  • Posts: 15
Aha, thats good to know, thanks...

100 per minute? Damn... It's weird though, last week I had 80bpm this week its all calmer. It has it's 'season' apparently.

Greetz

_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline eric48

  • Member
  • Posts: 1,264
Now 5 years! and still on the same combo.

Can't see any reason for a change... using Dr Cohen's FOTO was a great help and still doing good in the 4 days ON/ 3 days OFF trial. I do know that I am still UD with CD4 in the 1000, So ... HIV is now really on the back burner.

Working on new plans for 2016. We will see...
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

  • Member
  • Posts: 15

Well, great! So five years, no serious side effects (can I say that) and a relatively normal life. Cool.

I got new results, put them in the footer of this post.

Life has become normal again, I even found a new job and I actually like it very much. Looking on the difference of persoective between februari and now. Djeez. But I have to say being able to do it by myself and not having the PR-task added to the worries helped a lot. The doc suggested it. It works, I think.

Up till now I told one close friend and I told him that if it ever were necessary he should ask himself if it served a positive effect of some kind to share it. Bit weird, he thought so too. But apperently I wanted to tell someone.

Someone wanted unsafe sex a few nights ago and that was weird. Saying that I prefer to use a condom was easy, but I was wondering what to say  if I wanted to find out if the other person has hiv too...

Is there anybody else reading this other then you, Eric? Just curious. Whoever reads this, be good!  :)
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline eric48

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  • Posts: 1,264
Is there anybody else reading this other then you, Eric?

Yes, you'd be surprised the number of readers and PMs I get ... This is a combo that is used by 1-2 % of patients in 'rich' countries. But in poor 'countries', where people have moderate access to Internet, sometimes language barriers (they can read, but, may find difficult to post) and restricted access to the meds, there are MILLIONS of Nevirapine users.

Just to take the exemple of Nevirapine, not everyone can stand the drug and that is a fact. But for those who can, then it works and is easy to take.

Recently, some longtime users of NVP (Nevirapine aka Viramune) have switched the Dolutegravir (aka Ticicay), sometimes with a reason some times just because, yes, revisiting meds choice is a good policy, because , then you dilute the hidden side effects that may be there without you noticing it.

Further on, as we age, our doctor prescribe other stuff, such as cholesterol owering drugs, glycemia lowering drugs, etc. and you initial choice, should be revisited.

I am considering such a switch myself... I can expect to live well into my 80', so that is another 30 y. to go and I am certainly not married to this combo. I can't even think that I will not change. I will change, one day... Over the next 30 y. there will come reasons to change and I am glad to see that there are more and more good options on the table. Not all testomonies on that switch are adament, and sometimes people just consider going back to their good old combo.

But so far so good ... So, I am fine with it.

I can see you are doing very well to !

VL = 30 means VL < 50 ! So you know it works. This is not <20 and that +10 may sound frustrating but this is not... I also had a 24 ... So you have reached <50 (which is the success cut off) in 2 months !
And CD4 from 330 to 770. In just 2 months...

Question : Which form of Nevirapine are you using ? Generic? Extended release ? Do you still take twice daily or has your doctor allowed for a once daily dose ?

Look, this is very good! Keep working on it... You will reap the benefits ...
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

  • Member
  • Posts: 15
Hey Eric,

Well, if we're being read I guess it adds to the pleasure of the forum. Hope more people will join us, that would be nice. 😊 thanks for your kind reply. Appreciate it!

The Nevirapine is taken once a day, called Viramune, extended release. I'm not sure how to check if it's generic, since I don't know what it means.

I asked my doctor why he chose this combo and it fits your desciption: it's effective, easy to use, 'forgiving' - as he calls it, because if you take it later or forget it, there isn't an immediate problem. And no side effects if it fits you. I also asked if it's the price, he said it's also part of it, but not the main reason, since he has the freedom to prescribe as he pleases.

Hope I answered your questions, thanks for your answers too. I have some more...
1. Why are you such a strong supporter, because of your extensive study into it?

2. Once I achieve an undetactable viral load, what does this mean for my blood or sperm infecting someone else? Are there studies into this? I want to research this. 

For now, hugs!


_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline Saintfranciscus

  • Member
  • Posts: 15

Update: Last visit to the doc he measured the level of medicine in my blood in the moment just before the new pills of the day started to work. So they measured the amount of medication in my bloodstream at the lowest moment, furthest away from the new moment of intake. (Djeez I hope this is propper english in some way...  :) )

That wasn't enough, apparently I am a quick metaboliser, which sounds like I know have super powers, but in this case it's a pitty, because the 400 mg with the extended release are not compatible with that. The level of medicine in my bloodstroom during the last moments before the new pills is too low and this could cause resistence against the meds.

So they thought of switching to another regimen, Truvada was discussed, but before they do that they will try 3 x 200mg tablets. The idea behind this is to create a peek of medicine which will then take longer to extract from the blood.

A new bloodtest is planned, to see if this strategy works.
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

Offline Pozitivist

  • Member
  • Posts: 10
 Hi eric, i am 48 too, and got the v 6 months ago, and due to rapid drop of my t cells 307 to 201 ( some people are like this doc said though they are new to the v; and unfortunately i am one of them) in three months time my Dr started the truvada stocrin ( sustiva ) treatment.  Efevirenz at the begining  was a real shit especially at the very first three weeksbut now we Are happy together after three months.  😜 my vl dropped from 1500000 to 1000 and cd4 s rose from 201 to 430..  Hope you'll get better with your treatment i can only suggest trust your doctor and ignorance him with every change of your body which alarms you.. Take care;  love.

Offline Pozitivist

  • Member
  • Posts: 10
I ment to say inform him... Sorry... Damn the touchpad.. 😁😜😃😃

Offline eric48

  • Member
  • Posts: 1,264
... to see if this strategy works.

A bit of history migh help you:
Traditionnally, NVP (Nevirapine aka Viamune immediate release) was used in the following fashion:
2 weeks of boot up at 1 x 200 mg / day
then (after liver enzime screening, etc...), if all goes well, 2 x 200 mg, twice daily, (typically one in the morning and one in the evening, 12 h. apart)

There has been 2 evolutions from that:
A- the 2NN and ARTEN trials demonstrated that , for treatment experienced people, 2 x 200 mg, once daily (taking the 2 pills together) was

better than twice daily. But, the manufacturer did not bother refile FDA approval for this. So this is an OFF-Label usage, that most doctors approve of.
(When are you 'treatment experienced' (i.e. no more 'treatment naive') ? There is no precise definition but, say, 6 months after start of treatment seems reasonnable) : so that makes it a once daily (event though you have 2 week boot up and 6 months of bi-daily)
This can be done with generics or the old Viramune (standard relase)

B- 2 y. ago, The Original manufacturer , Bohringer, introduced a once daily pills (aka Viramune XR), which is an impregnated foam, that dissolve slowly though the digestive track. This is FDA approved and makes it a once daily, as per the registered label. This way the manufacturer can compete with other once daily regimen and retain patents rights for another 20 y. This is not a generic.

For the patient, though, it does not make much difference, if you are comfortable with the once daily OFF label. (my doctor offered it, so that is why I used it)

Throughtout the years, Nevirapine (2 x 200mg) has shown very good long term efficacy.
Is this efficacy retained when you go OFF label ? Yes, doctors have thousands of patients to support that
Is this efficacy retained when you go with the new XR pill ? Well... The pill is recent, so doc was right to question the level of drug.

I used the New XR for a while, but since the OFF label had been succesfull for me, was cheaper, and easier to take, I , just like yourself returned back to the good old 200 mg pills.

With the kind of impressive numbers you are posting, the Viramune XR has not failed you... But your doctor is taking a safer route... Why not... Since you are back to the 'old' technique', and since you are not yet 6 months into treatment, then taking your pills bi-daily may be the best for the time being. And then you can discuss with Doc in order to get back to once daily. The Twice daily should only be temporary.

That is for the practical aspects...

Then the conceptual aspects: your levels were 'low', but the results where good. So 'low' compared to what ? 'low' compared to a 'target' : the target is 4000 ng/mL. But when you dig a bit, you find that authors to not agree on the so called 'target' and some higher and some lower values has been proposed...

That shoud not confuse you... The 3x200 mg should resolve that

Then, you will most likely go back to 2 x 200 mg, once daily OFF label, which in practical terms, for the patient, is a once daily and that is it.

The 200 mg  has generics, which is nice. Further on I found that all generics comply with the same high standards, but some manufacturers make smaller pills (for the same amount of drug). You may want to discuss that with you pharmacist. I chose the smaller I could get and they are indeed very tiny.
NVP/ABC/3TC/... UD (non-infectious) ; CD4 > 1000; CD4/CD8 ~ 2.0   stock & donations : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: use of NVP & 3TC generics
https://clinicaltrials.gov/ct2/show/NCT02157311

Offline Saintfranciscus

  • Member
  • Posts: 15
Thanks for the input, it matches, apart from the moment, they want me to take 3 x 200mg at once.

Keep u posted on how this works. Hugs
_________
01/15 - Infection
02/15 - Test + diagnose.
02/15 - VL: 141000 - CD4: 0.33
03/15 - Start meds: Kivexa + Nevirapine
04/15 - VL: 1040 - CD4: 0.60 - CD4/CD8: 0.69
05/15 - VL: 30 - CD4: 0.77 - CD4/CD8: 0.86

 


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