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Author Topic: Nuke-Sparing Regimen anyone?  (Read 2085 times)

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Offline jaguarpaw

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  • Posts: 30
  • Livin' a positively good life!!
Nuke-Sparing Regimen anyone?
« on: August 22, 2010, 04:42:16 PM »
Lately I have been reading on Tenofovir and the potential loss of bone mineral density while on this nuke. Mineral density seems to drop sharply shortly after Tx, then stabilizes then drops again after two years. In addition other issues, like increased kidney toxicity.

With the availability of Integrase inhibitors, there seems to be an increased interest in studies testing a recommended non-nuke regimen.

I would assume that some readers of this forum would be on a NRTI-sparing regimens because of eventual loss of efficacy due to resistance.

I am interested in exploring unboosted Reyataz + Isentress.    

I am currently non-detectable, without documented resistance according to genotype lab.

Is anyone on a simplified 1st or second line treatments without nukes?
« Last Edit: August 22, 2010, 05:04:36 PM by jaguarpaw »
Poz Dx 08/09
     
            CD4/%     VL
08/09   407(30) 280,000 acute infx suspect'd
11/09   520(31)   44,000
05/10   450(30)   78,000 meds considered
06/10   *Begun ARVs - Isentress + Truvada* 
07/10   550(31)       49- 1 copy away from UD!
10/10   668(32)    <48 UD
01/11   608(34)    <48 UD
04/11   670(36)    <20 UD
07/11   711(38)    <20 UD
11/11 1005(45)    <20 UD

Offline Assurbanipal

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Re: Nuke-Sparing Regimen anyone?
« Reply #1 on: August 22, 2010, 05:32:13 PM »
Hi

I'm not on a nuke sparing regimen per se, but I don't have tenofovir/viread in my regimen any more.  Instead I replaced Truvada with Epzicomm.

Frankly, I wouldn't worry much about the kidney issues with viread.  If you have a good doctor they will be monitoring your kidney function (via the GFR ) when you get your regular blood work and there is plenty of time to act to change medicines before any long term kidney damage is done.

Bone mineral density is a different issue.  The reason I wanted off viread was because I have developed osteoporosis, and -- given my set of risk factors -- HIV and viread are the likely culprits.  But, this is a problem because it crept up on me and my doctor a few years back when the literature was not so focused on the potential for osteoporosis.  At this point, rather than rule out a combo, it might make more sense to talk with your doctor about what tests and monitoring are required to make sure that any problem that does occur is caught before it is harmful.

You see, it is often the things we don't know about the potential side effects that are hardest to prevent.  And that is where drugs like viread, which are a component of the most popular starting combo on the market (Atripla) and have a long history, have an advantage over newer drugs like Isentress.  So far Isentress looks like it has a really good side effect profile -- a few people (including me) can't tolerate it because it eats away at their muscles (rhabdomyolosis) but most people love it.  But most people also love Truvada (which contains viread) and we have a lot more data on what to watch out for with it.

Finally, if you are interested in seriously pursuing a nuke sparing regimen have you thought of searching for a clinical trial?  There are advantages to you in being part of a trial (free meds and intensive monitoring) and a benefit to society (actually testing in a controlled manner to see whether nuke sparing regimens are better).

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 Hellraiser

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Re: Nuke-Sparing Regimen anyone?
« Reply #2 on: August 22, 2010, 07:03:07 PM »
So I'm not really good with figuring which medications go together but wouldn't it be possible to go with

Selzentry (Maraviroc) = Entry Inhibitor

+

Isentress (Raltegravir) = Integrase Inhibitor

+

Norvir/Prezista           =  Protease Inhibitor

That would be a 3(4) drug combo that has no NRTI in it, but I've not heard of anyone who isn't on salvage therapy going with anything that doesn't involve Truvada in some form.

Offline Inchlingblue

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Re: Nuke-Sparing Regimen anyone?
« Reply #3 on: August 22, 2010, 11:09:14 PM »
I'm on Isentress/Truvada and I've been following the studies on Isentress/Reyataz pretty closely. It looks like a promising combo that could work but I think it's too soon to try it until there's more data.

There have been a few small non-randomized studies that were promising but there is currently a bigger clinical trial ongoing that might be able to definitively determine if it works.

Offline Billy B

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  • Posts: 374
Re: Nuke-Sparing Regimen anyone?
« Reply #4 on: August 23, 2010, 11:28:19 AM »
I am also on I&T and before starting I discussed the Isentress/Reyataz combo with my IDS. We went with the I&T because the Isentress was metabolized by the liver and the Truvada was metabolized by the kidneys. Isentress/Reyataz are both metabolized by the liver. As an older one with a liver that has been to a bar or two and since I have excellent kidneys, my IDS thought it better to spread the load on two organs.
Billy
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline loop78

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  • Posts: 147
Re: Nuke-Sparing Regimen anyone?
« Reply #5 on: August 23, 2010, 12:34:31 PM »
I'm on Isentress/Truvada and I've been following the studies on Isentress/Reyataz pretty closely. It looks like a promising combo that could work but I think it's too soon to try it until there's more data.

Inchling, do you know if those studies are looking at isentress plus boosted or unboosted reyataz?

I guess it'll probably be boosted, but I would be interested to know.

Thanks in advance!

Offline jaguarpaw

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Re: Nuke-Sparing Regimen anyone?
« Reply #6 on: August 23, 2010, 02:21:24 PM »
Hey Loop78,

you can search onine for these studie's data.
Un-boosted Reyataz/Isentress is the focus of the SPARTAN study. There is data out there as well combining Kaltera(boosted)/Isentress.

Here is the link for three studies that spare NRTIs one of them being SPARTAN

http://www.hivandhepatitis.com/2010_conference/AIDS2010/docs/0730b_2010.html

It looks like the spartan pilot study has been halted due to increased hyperbilirubimia (Isentress raises the blood levels of reyataz therefore increasing the risk of jaundice) and also, more distressing, because a number of participants became resistant to Isentress. No one developed resistance to Reyataz.

I know I would hate to lose Isentress that is why I am sticking to the recommended treatments now, but I have thought about the idea of asking my doc to add Reyataz on top of Isentress/Truvada, then phase out the Truvada for maintenance therapy consisting only of Isentress/un-boosted Reyataz.

Also I'm interested to see, in the future once other Integrase inhibitors become approved, if there will be an effort to combine two INIs with another drug. (much like the dual NRTIs used today and a 3rd drug)

Poz Dx 08/09
     
            CD4/%     VL
08/09   407(30) 280,000 acute infx suspect'd
11/09   520(31)   44,000
05/10   450(30)   78,000 meds considered
06/10   *Begun ARVs - Isentress + Truvada* 
07/10   550(31)       49- 1 copy away from UD!
10/10   668(32)    <48 UD
01/11   608(34)    <48 UD
04/11   670(36)    <20 UD
07/11   711(38)    <20 UD
11/11 1005(45)    <20 UD

Offline Zohar

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  • Posts: 248
Re: Nuke-Sparing Regimen anyone?
« Reply #7 on: August 23, 2010, 03:57:59 PM »
''Norvir/Prezista           =  Protease Inhibitor''

These drugs are prescribed with Truvada for the full combination.
''Poor is the man whose pleasures depend on the permission of another.''

 


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